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TRANSACTIONS 
& STUDIES 

of 

The College of Physicians 

of 

Philadelphia 



FOURTH 
SERIES 




VOLUME 37 
i 9 69-70 



WAVERLY PRESS, INC. 
Baltimore^ Md. 21202 



The College of Physicians of Philadelphia does not as- 
sume responsibility for statements or views expressed 
by contributors to the Transactions Studies. The 
editor checks bibliographic references, to aid in making 
them factually reliable, and occasionally supplies head- 
ings in the text, to facilitate reference to clearly defined 
portions of the text; the communications are in other 
respects printed exactly as they were submitted, sub- 
ject to author corrections on the galleys. 

An index to the annual volume of the Transactions & 
Studies appears in the fourth and final (April) number 
of the volume. 

The communications pertinent to their respective 
fields are indexed in : Biological Abstracts; Chemical Ab- 
stracts; Index Medic us. 



The Transactions & Studies of The College of Physicians of Philadelphia is published four times a year — 
July, October, January, April — at Baltimore, Maryland by the College of Physicians of Philadelphia. 

Subscription, $5.00 a volume. Single copies, $1.25. 
Publication Office: Mt. Royal and Guilford Aves., Baltimore, Md. 21202. Editorial correspondence should 
be addressed to: The Editor, The College of Physicians of Philadelphia, 19 South 22d Street, Philadelphia. 
Pa. 19103. Entered as second class matter June 21, 1938, at the Post Office at Baltimore, Md., under the 

act of August 24, 1912. 
Printed in U. S. A. 



Contents 



No. 1, July 1969 
Population Avalanche (Mary Scott Newbold Lecture XL) 

Chairman Francis C. Wood 

Moderator Luigi Mastroianni, Jr. 

Participants 

Bernard Berelson, Alan F. Guttmacher, Benjamin Viel 1 
Life and Health Insurance Today: A Survey for the Practicing Physician 

Introductions Francis C. Wood, Theodore H. Mendell 

Chairman Vaughan P. Simmons 

Participants 

Arthur E. Brown Walter A. Reiter, Jr. 

Gerald D. Dorman Paul I. Robinson 

Albert L. Larson William A. Sodeman 

Robert S. Pressman R. Robert Tyson 

D. Sergeant Pepper Joseph C. Wilberding 29 

Metabolic Bone Disease — Facts and Fancy (Thomas Dent Mutter Lecture 

LXXX) Ernest E. Aegerter 71 

Memoirs 

Leigh ton Francis Appleman (1874-1968) Warren S. Reese 80 

Joseph Howard Cloud (1872-1968) Victor C. Vaughan, III 82 

Archer P. Crosley, Jr. (1920-1968) John Kapp Clark 86 

John Arthur Daugherty (1902-1968). . .Edward C. Raffensperger 83 

Andrew J. Donnelly (1910-1968) Paul J. Grotzinger 88 

Matthew S. Ersner (1890-1968) David Myers 84 

Francis Clark Grant (1891-1967) Robert A. Groff 89 

William E. Krewson, III (1908-1968) Edmund B. Spaeth 91 

William Harvey Perkins (1894-1967) 

Thaddeus L. Montgomery 93 

William Whitaker (1880-1968) Frederic C. Sharpless 96 

No. 2, October 1969 

Dr. William Bryant (1730-86): American Physician and Antiquary 

(Kate Hurd Mead Lecture XX) Fred B. Rogers 99 

Thomas Jefferson and the Doctors Samuel X. Radbill 106 

Felix d'Herelle and Bacteriophage Therapy (Edward Bell Krumbhaar 

Prize Essay VIII) Steven J. Peitzman 115 

The Public Practice of Midwifery in Philadelphia 

W. Robert Penman 124 
Notes on the History of Medicine in Hungary George Polgar 133 



iv 



CONTENTS 



Medicine^Music and Academia F. William Sunderman 140 

Distillates from Hieronyinus Brunschwig's Book of Distillation 

Marion B. Savin and Harold J. Abrahams 149 

A Dozen Portraits in the College Hall Fred B. Rocers 158 

List of the Kate Hurd Mead Lectures in Medical History, I-XX 166 

Memoirs 

William Bates (1889-1967) Norbert J. Schulz 167 

Martin W. Clement (1881-1966) John Kapp Clark 169 

Edward Foulke Corson (1883-1967) Herman Beerman 171 

John Arthur Daugherty (1902-1968) Allen W. Cowley, Sr. 173 

J ohn^Evan Davis (1908-1968) Baldwin L. Keyes 174 

Samuel Creadick Rhoads (1900-1968) Warren S. Reese 176 

Reuben Lore Sharp (1897-1968) Thomas M. Kain, Jr. 177 

Calvin'Mason Smyth, Jr. (1894-1967). . . .Tito Augustine Ranieri 178 
Transactions of the«Philadelphia Neurological Society, 1968-69 181 

No. 3, January 1970 

Health Care for theJ970's (James M. Anders Lecture XLVlll) 

Joseph T. English 191 
125th Anniversary Salute: The Philadelphia Birthplace of the American 

Psychiatric Association Robert Erwin Jones 198 

Memoir of Sir Henry Hallett Dale (1875-1968) 

George B. Koelle 202 



The Custodianship Cabinet of The College of Physicians 205 

Venerable But Vigorous: The College of Physicians 

Lucinda P. Rose 243 

The Council of The College of Physicians 246 

The Staff of The College of Physicians 248 

New Fellows of The College of Physicians 250 

Memoirs 



Delazon Swift Bostwick (1893-1968). . . .Herbert J. Dietrich, Jr. 254 

Theodore Cianfrani (1899-1968) Joseph H. Zeigerman 256 

WalterS. Cornell (1877-1969) Herbert W. Cornell 257 

Lewis Kraeer Ferguson (1897-1968) Paul Nemir, Jr. 259 

Harrison Fitzgerald Flippin (1906-1968) 

Charles A. W. Uhle 262 

Abraham Mapow (1907-1969) Frederick Harbert 265 

Ford A. Miller (1895-1968) John D. Corbit, Jr. 266 

Gerald H. J. Pearson (1893-1969) Bernard J. Alpers 267 

Stanley P. Reimann (1891-1968) Timothy R. Talbot, Jr. 270 

Helena E. Riggs (1899-1968) Russell S. Boles 273 



CONTENTS 



v 



Lennard L. Weber (1915-1969) S. Leon Israel 275 

A Letter from the Benjamin Rush House Committee 277 

No. 4, April 1970 

Neurosurgery in Philadelphia 

The Philadelphia Neurosurgical Society 

Frederick Murtagh, Jr. 281 
Dr. Max Peet and His Contributions to Neurosurgery 

Philip D. Gordy 285 

The Massa Hoax R. Norton Hall 286 

Multiphasic Health Testing (Arthur Parker Hitchens Lecture XIII) 

Joseph H. Boutwell 291 
Philadelphia Medicine in 1841 as Seen by a Visiting Physician 

Harold J. Abrahams and Wyndham D. Miles 295 

Memoirs 

S. Jen-is Brinton (1892-1969) Frederick C. Sharpless 305 

John Westgate Hope (1914-1969) C. Everett Koop 306 

David Warren Kramer (1890-1969) Harold L. Israel 308 

Eugene A. Meyer (1903-1969) Oram R. Kline 309 

George Gordon Snyder, Jr. (1908-1969) 

Thomas F. Furlong, Jr. 310 

Annual Reports 

President's Address Francis C. Wood 311 

Secretary, 312; Treasurer, 314; Library, 315; Mutter Museum and 
College Collections, 336. 

List of College Lectures, 1969 339 

Transactions of the Sections 340 

Officers, Committees, Sections and Administrative Staff of the College, 

1970 342 

List of Fellows 347 

Suggested Form of Bequest 372 

Index to Volume 37 373 



1 

I 

I 

I 

' 

( 
I 



TRANSACTIONS V STUDIES 

of 

The College of Physicians of Philadelphia 



Volume 37 
(Fourth Series) 




Number i 

(July 1969) 



Population Avalanche 

The Mary Scott Newbold'Symposium* 
Chairman 

FRANCIS C. WOOD, M.D., President, The College of Physicians 

of Philadelphia 

Moderator 

LUIGI MASTROIANNI, JR., M.D., Chairman, Department of Obstetrics 
and Gynecology, School of Medicine, University of Pennsylvania 

Participants 

BERNARD BERELSON, President, The Population Council, 
New York, New York 

ALAN F. GUTTMACHER, M.D., President, Planned Parenthood World 
Population, New York, New York 

BENJAMIN VIEL, M.D., Professor of Preventive Medicine, 
University of Chile, Santiago, Chile 



(Dr. Wood) I should like to welcome you 
all this morning to the symposium, given 
under the auspices of the Mary Scott New- 
bold Fund, on what we call the "Popula- 
tion Avalanche." 

Years ago, in the 1780's and 1790's, this 
College of Physicians was the only group 
of physicians in Philadelphia interested in 
the public health and the public welfare. 
Along came the AMA, the county societies, 
and the boards of health, and this College 
more or less abdicated in favor of those 

• Mary Scott Newbold Lecture XL, The College 
of Physicians of Philadelphia, 1 March 1969, pre- 
sented as a symposium. 



groups. A few years ago we decided that 
the human race was messing up the world 
and that we as physicians and citizens didn't 
know quite as much as we should know 
about these problems, so we started a 
series of symposia. This is our fourth. Pos- 
sibly it should have been the first, because, 
if we didn't have a population avalanche, 
we wouldn't have air pollution, water pol- 
lution and all that sort of thing. 

We have assembled today a group of 
people who know what they're talking 
about in this field. I shall now introduce 
the moderator of this panel, Dr. Luigi 
Mastroianni, Chairman of the Department 



2 



THE MARY SCOTT NEWBOLD SYMPOSIUM 



of Obstetrics and Gynecology of the Uni- 
versity of Pennsylvania School of Medicine 
who has been very much interested in this 
area and who has assembled this panel for 
us. 

(Dr. Maslroianni) I don't suppose it's 
necessary to emphasize the great im- 
portance of the subject under consideration 
today; the great increase in the world pop- 
ulation has become a fact. It's a fact with 
which we are now living, and the effects of 
the increasing population are felt in every 
facet of our society. 

Of course, as an obstetrician and gyn- 
ecologist, I look upon this as something 
more than a demographic problem, and 
I suppose I've been conditioned to consider 
the importance of family planning in terms 
of the lives of my individual patients. 

One of our panelists, Dr. Berelson, 
has referred in past writings to "effective 
personal freedom," and actually part of 
our task in academic obstetrics and gyne- 
cology is to develop methods which will 
make it possible for each woman in the 
world to exercise "effective personal free- 
dom." The problem is a broad one and the 
expertise which will be brought to it by 
the members our distinguished panel ranges 
in discipline. 

First, we have Dr. Bernard Berelson. Dr. 
Berelson's background has been varied. 
Along the way, he was a Dean of the School 
of Library Science at the University of 
Chicago and subsequently he found him- 
self in the broad field of sociology. He 
was a Professor of Sociology at the Uni- 
versity of Chicago and later a Professor 
of Sociology at Columbia University. About 
a year and a half ago, he was appointed 
President of the Population Council in 
New York City. The Population Council, 
as many of you know, is an organization 
whose efforts are devoted to a study of pop- 
ulation problems throughout the world. 

Next, we have Dr. Benjamin Viel. Dr. 
Viel's field is preventive medicine, and he 
is a Professor of Preventive Medicine 



and the Chairman of the Department at 
the University of Chile. 

For many years, Dr. Viel has worked 
in the field of public health or, if you 
will, preventive medicine. The main 
thrust of his activities has been in maternal 
and child welfare. Naturally, the field of 
family planning is one which has close 
association with maternal and child health. 
Dr. Viel has had considerable exposure to 
the United States, having studied at both 
Harvard and Johns Hopkins. His work in 
the field of population control has been 
recognized as pioneering, especially as it 
relates to the problem in Latin America. 

We also have Dr. Alan Guttmacher. Dr. 
Guttmacher is an obstetrician and gyne- 
cologist, I am proud to say, and he is Pro- 
fessor Emeritus at Columbia University in 
obstetrics and gynecology and former Chief 
at Mount Sinai Hospital in New York. 
Presently, Dr. Guttmacher is President of 
Planned Parenthood World Population. He 
has done much to bring the population 
avalanche to the attention of the American 
public and to the world. 

We will ask each of the panelists to 
make an introductory statement. We will 
start with Professor Viel who will address 
himself to the problem as it relates to 
Latin America. 

Can the Demographic Explosion be 
Stopped in Latin America? 

(Dr. Viel) The Latin American continent 
cannot be considered as a homogeneous 
unit. In its vast territory, we find all kinds 
of climates, a wide variety of cultures and 
different traditions, as well as a racial mix- 
ture, which ranges from the European im- 
migrant, who has maintained the purity of 
the white stock in Argentina and Uruguay, 
to the pre-Columbian native, who has not 
yet been mixed in some areas of Mexico, 
Guatemala, Ecuador and Brazil. Between 
both extremes there are racial mixtures of 
white, Mongolian and black, each giving 



POPULATION AY \! \NCIIK 



3 



its own characteristic to countries and 
j regions. 

The tremendous cultural efforts of Spain 
and Portugal left, as inheritance, a com- 
I mon religion, the Roman Catholic, and 
two languages, Portuguese in Brazil and 
Spanish in the territory south of the Rio 
Grande, with the exception of Haiti and of 
British and Dutch posessions in the Car- 
ibbean. 

During the Spanish domination and 
even during the last decades of the 20th 
Century, the predominant production in 
1 all Latin America was agriculture and the 
only sources of energy were men's muscles 
and domestic animals. In such conditions, 
the existence of a generalized pre-natality 
policy was quite logical. Immense terri- 
tories available for cultivation and the lack 
1 of labor were sufficient justifications for 
' the landowners to encourage birth by all 
means, even forgetting the religious teach- 
' ings that advocated the formation of a 
; family under the norms of a responsible 
1 parenthood. 

The Independence War, long and cruel 
in many places of America, was followed 
} by a period of anarchy perhaps longer and 
' more cruel than the war against Spain; 
s both added to our continent a new tradi- 
tion, heroic patriotism. A breed of men 
willing to die for their countries, but 
rarely in disposition to work for their 
) betterment, continued with weapons in 
their hands in a succession of revolutions 
i and guerrilla wars. They devastated fields 
and cattle, impoverished areas which be- 
fore were productive, and in their wander- 
ing as warriors did not have time to 
i establish families. The children born of 
j different women and in distant lands 

I i learned early to admire the man able to 

II : impregnate the female, but not to love 
i her, as well as the man brave enough to die 

)t j in battle, but unable to adjust himself to 
), the routine of a daily work, 
n For those who were not born landlords, 
jf I only the priesthood and the military 



career could change the course of their 
lives. The Independence War did not 
damage the power of the Catholic Church, 
l)iu incorporated into our cultural heritage 
a piouounccd militarism, for whose con- 
sequences we are still paying today. 

With the process of industrialization, 
changes have taken place, mainly in the 
areas in which this process has been pos- 
sible and successful, as it has been in the 
South Cone of the continent, Mexico, and 
the South of Brazil. But the great majority 
of our countries are still living in an agri- 
cultural-commercial economy. 

Where there is an industrial develop- 
ment, there is a peasant migration to the 
city. The percentage of urban population 
increases and becomes a relatively good 
indicator of the degree of industrial de- 
velopment reached. 

If, instead of dividing Latin America 
into geographic or climatic areas, we divide 
it according to the percentage of the popu- 
lation living in urban settings, it is possible 
to have a more realistic idea about the 
most characteristic facts associated with the 
present demographic condition. Using the 
basic data given by the study of Puffer and 
Griffith (1), we have selected some coun- 
tries and grouped them according to the 
percentage of population that in 1960 was 
classified as urban, and we have compared 
these data with the percentage of the pop- 
ulation that in the same year was located 
in cities of over 100,000 inhabitants. When 
both percentages were high for a given 
country, we classified it as an urbanized 
society with all the proper characteristics 
of an industrial system of production. 
When both percentages were low, we con- 
sidered the country as rural and conse- 
quently as having the type of organiza- 
tion proper to an agricultural-commercial 
economy. Between both types of countries 
remains a group that could be considered 
as intermediate, that is to say, in the first 
stage of industrialization and facing the 
problems of such a period, but with the 



I 



THE MARY SCOTT NEWIiOLD SYMPOSIUM 



only difference that these countries the 
mortality rate is relatively low, or at least 
lower than the one Europe had in the same 
stage. The difference we are mentioning is 
not the consequence of an ecological equi- 
librium, but the result of the knowledge 
we have now to fight the infectious dis- 
eases. 

Classifying 16 countries with the indi- 
cated criteria, we have only Argentina and 
Uruguay in the urbanized area. Seven 
countries appear in the intermediate area: 
Brazil, Colombia, Chile, Mexico, Panama, 
Peru and Venezuela. In the rural area are 
included the following seven countries: 
Costa Rica, Guatemala, Ecuador, Hon- 
duras, Nicaragua, Salvador and Paraguay. 

The lack of statistical information is the 
reason we could not classify the Caribbean 
countries, but the knowledge we have 
about them makes us think that with the 
exception of Cuba, all of them could be 
included in the rural area. 

In each of these three areas, we have con- 
sidered (Figure 1) the mortality per thou- 
sand inhabitants, the percentage of dead 
children under 5 years of age over the 
total number of deaths, the birth rate, the 



ratio between the number of children en- 
rolled in the schools and the total school 
age population, and finally, the expected 
population in the year 2000 if the observed 
conditions for 1960 do not change consid- 
erably. 

There is no demographic problem in 
the urbanized area. Its present low birth 
rate allows one to predict an increase to 44 
million inhabitants for the year 2000, 
which is still a smaller number of people 
than Argentina and Uruguay are able to 
feed from their vast prairies and with their 
immense natural resources. In contrast, 
the intermediate area more than duplicates 
its population, and the rural area tripli- 
cates its population in the same 40 years. 
If the health and educational indicators 
show a serious situation, the most simple 
analysis has to conclude that with such 
rate of population growth, the situation 
could get worse at the beginning of the ) 
coming century. Therefore, a vast area of 
our continent is bound to suffer a similar 
or worse tragedy than India is facing today, 
unless rational measures are taken now to 
avoid the catastrophe. 

It would be naive to think that the 



SOME DEMOGRAPHIC FEATURES IN A GROUP OF LATIN AMERICAN 
COUNTRIES IN I960 



70 



10 



DISTRIBUTION OF POPULATION 


DEATH 


BIRTH 


EDUCATION 


POPULATION IN 1960 AND 
IN 2000 


(=E 
OF 
PO 


3CF 
PUl 


NTAGE 

BAN 

ATION 


PEI 
LIV 
CIT 
1 

70- 
50- 
30- 
10- 


!CE 
IN' 
IE! 
30.( 


N 

5 
i 

)0 


TAGE 
N 

DVER 
) 


DE 
PE 

12- 
10- 
8- 
6- 
«■ 
2- 


AT H 
R 1 


91 
5 


RATE 

)0 


RA 

DEAl 
5 0\ 
DEAl 

50- 
30- 
10" 


10 
■H I 
I E R 
Hit 

I 



JN 

T 
VE 


F 

DER 
OTAL 
RAGE 


Bl 
PE 

50- 
30- 
10- 


R 

I 


H 
1( 


1 

: 

5 

} 

'•2 


(ATE 



RATIC 
GISTE 
SCH0( 
DREN 
PULAT 

050- 
030- 
010- 


) ' 
R 

5L 

10 


)F 
ED 
C 
/E 
N 


f 

H 
R 
5 

1 
\ 

I 


!E_ 

L. 
PO. 
-14 


480- 
470: 
150 : 

120- 

„ 100- 

z - 

2 80- 
_1 

_J 

2 60- 
40- 
20- 


\ 


X 


I 

in 





POP I ' I VTION A\ Al.ANC.ni. 



5 



present conditions in Argentina and Uru- 
guay are the consequence of the high 
percentage of urban population. Such per- 
centage has been achieved through a cen- 
tury of increasing industrialization. The 
European inmigrants, who left Europe 
with a concept of responsible parenthood, 
established their families in the Argentine 
prairie, but, after working in the rural 
areas, abandoned them, attracted by the 
industrial inducements or by the displace- 
ment produced by the progressive mech- 
anization of agricultural activity. In the 
city, they passed through a transition 
period, characterized by high birth rate 
i and low mortality, but subsequently they 
i. passed through a period of decreased birth 
; rate, and, as in Europe, this occurred 
e without the use of efficient contraceptives, 
without a proper contraceptive education 
and even before anybody spoke about 
ie demographic explosion. This was the logi- 
)[ cal consequence of the difficulties of urban 
it life, which were increased by the progres- 
sive decrease of mortality of a human 
tc group whose ancestors had for a long time 
, a concept of responsible parenthood. It 
ie was this concept that produced the miracle 
before a solution was suggested by medi- 
cal doctors, demographers or sociologists. 
What we are observing today in the 
: I intermediate area of our classification does 
not necessarily indicate that a similar 
phenomenon is occurring. The death rate 
I has decreased in a short period of time; 
the mechanization of farming together 
with industrial growth have encouraged 
peasant migration, but nothing indicates 
( so far a spontaneous decrease of birth 
rate, and, where such decrease exists, it can 
be explained by the presence of a middle 
class acting in the same way that the 

1 European inmigrants of Argentina acted at 
| the beginning of the century. 
Because of the fact that the newcomer to 
the city usually is a man still attached to 
rural traditions, who does not associate the 
decrease of mortality with the importance 



of birth control, we can observe among the 
marginal populations of our cities some- 
thing similar to what happens in rural 
areas, i.e., the large family and high fer- 
tility. Only in some isolated areas and in 
certain countries is the practice of illegal 
abortion common. 

The frequency of induced abortion is a 
phenomenon which is being studied with 
increasing interest. It could be stated that 
in 1960 such a method was the only way of 
birth control in Latin America. Since all 
countries have a young population distri- 
bution and the tendency to allow early 
sexual relations, it is easy to believe that 
the birth rate would be higher and no less 
than 50 per thousand. While no better 
indicators are found, a possible way to 
determine the frequency of illegal abor- 
tions lies in comparing the recorded birth 
rate of each country with the theoretical 
birth rate of 50 per thousand, which we 
figured as expressing spontaneous fertility. 
The difference between the two rates in- 
dicates the approximate frequency of ille- 
gal abortion, as it is shown in Table I. 

When the woman cannot resort to abor- 
tion, multiparity is the rule. If such 
multiparity coincides with economic in- 
sufficiency, one observes a kind of involun- 
tary "infanticide," whose data, taken from 
a study done in Chile by Faundez (2), can 
be appraised in Figure 2. 

It is evident that the present infant 
mortality, especially high among those 
born after the family has already 3 or 4 
children, could be related to the poverty 
that the increase in size is producing; but 
30 years of experience in medicine has 
convinced us that the unconscious desire 
of the mother to see her child die is also an 
important contributing factor. The later 
born are taken to the doctor only when 
they are seriously ill, and very often the 
instructions given by the doctor are not 
properly observed. 

A vast area of Latin America is victim of 
the demographic explosion. In some 



6 



THE MARY SCOTT NEWBOLD SYMPOSIUM 



TABLE I 



Country 


Hirth 
Rate 
in l you 


Difference 

from 
Theoretical 
Hirth Rate 


% of 
Urban 
Population 


Uruguay 


22.3 


— 27.7 


68.0 


Argentina 


22.5 


— 27.5 


66.4 


Brazil 


33.0 


— 17.0 


40.4 


Chile 


33.0 


— 17.0 


66.2 


Peru 


38.2 


— 11 .8 


47.1 


Venezuela 


42.8 


-7.2 


63.7 


Colombia 


44.6 


-5.4 


50.6 


Mexico 


44.7 


-5.3 


50.7 


Honduras 


44.2 


-2.8 


22.5 


Salvador 


48.5 


-1 .5 


38.5 


Costa Rica 


49.2 


-0.8 


34.5 



areas, induced abortion appears as a 
method of birth control, but in those areas 
in which the demographic growth is 
greatest, induced abortion is not com- 
monly practiced. This situation, plus the 
high infant mortality rate, associated with 
uncontrolled natality, gives rise to the 
following questions: Is Latin America ap- 
proaching the end of the transitional 
period? Is Latin America ready to start a 
spontaneous decrease of natality? In the 
rest of our continent, will the same phe- 
nomenon occur that has been changing the 
demographic situation in Argentina and 
Uruguay since the beginning of this cen- 
tury? 

The facts seem to indicate that the 
answers to these questions are negative, at 
least in the short run. Since men were 
victims for centuries of pre-natalistic teach- 
ings advocated by the landlords for eco- 
nomic and political interests, supported by 
religious norms and justified by the socio- 
economic conditions of the epoch, and 
since these men have not yet shared the 
concept of responsible parenthood, we 
cannot expect that they will forget their 
ancestors in a short period of time and be- 
have as the European group transplanted 
to Argentina did. 

For our native population, such under- 
standing cannot be sudden, and, if it has 
to arise spontaneously, maybe time will not 



allow a wait for such spontaneous decrease 
in numbers. Probably before we observe a 
decrease in birth rate, we shall see an in- 
crease of our death rate due to hunger, 
which already is manifesting its fatal re- 
sults in some areas of the continent. 

If everything seems to indicate that 
Latin America is in need of a policy of 
birth control in order to solve its present 
demographic problem, and if there are no 
precedents to anticipate a spontaneous 
evolution as a result of a cultural change 
in our population, then the only solution 
is to promote a population policy which in- 
cludes and encourages birth control. This 
is not an easy task, since there are a good 
number of opposing factors. 

From the social aspect, it seems neces- 
sary to insist on the negative influence of 
an ancestor formed in centuries by a pro- 
natalistic policy and accentuated by the 
so called "Machismo," which in our judg- 
ment is the consequence of the Independ- 
ence War and guerrilla wars that charac- 
terized the anarchy period which followed. 
Such "Machismo" does not have too mucli 
importance, except in the rural area, be- 
cause it tends to disappear rapidly under 
the influence of education in industrial 
environments. 

The social factor that seems to have the 



INFANT MORTALITY ACCORDING 
TO NUMBER OF BORN ALIVE 



300r- 



or o 
— o 
n- o 



UJ 200 



£E 0_ 
3 w 

Q <± 
< _l 
UJ 

Q c3 



100 



5$ 

oi lu 
z >- 



J I I L 



_L 



1-2 3-4 5-6 7-8 9-K> 11-12 13- More 

NUMBER OF BORN ALIVE FROM 
THE SAME MOTHER 

Fig. 2. 



POPULATION AVALANCHE 



7 



greater influence in our environment is 
poverty, which provokes a collective [lus- 
tration. In such a condition, there is no 
hope for progress, no family organization, 
no desire for more education; in brief, 
there is no faith in the future. This is the 
precise situation where a policy of birth 
control must be joined with a policy of 
economic development as two parallel 
elements that have to go together. Birth 
control will achieve poor results if it is not 
accompanied by an efficient economic de- 
velopment. Such economic development 
will not be successful if there is an un- 
controlled population growth. As a 
Chilean politician put it, economic devel- 
opment and family planning are the two 
airplane wings that Latin America requires 
for the take-off from underdevelopment. 

The Catholic religion is another factor 
of great importance nowadays. Until re- 
cently we were convinced that the discus- 
sion with the Catholic Church was only a 
matter of methods, since its continuous 
and profound teaching of the norm of 
responsible parenthood gave rise to a 
principle of agreement and the possibility 
ol a common understanding. The compre- 
hensible attitude and sometimes the coop- 
eration of many priests contributed to 
our optimism. The encyclical, "Humanae 
Vitae," issued in 1968, which put an end to 
four years of discussion in the Church it- 
self, defeated our optimism. The Catholic 
Church decided itself against birth control, 
unless practiced by a method which medi- 
cal science has proved as inefficient. 

The encyclical, "Humanae Vitae," has a 
curious peculiarity. In spite of its universal 
meaning, it seems to have been written ex- 
clusively for Latin America. Obviously, it 
will not have any influence in Asia, Africa 
or Oceania. Also, it is quite evident that it 
will not increase the present low birth rate 
of Europe and Anglo-Saxon America. Its 
influence will be felt only in Latin 
America. 

The way in which the policy imposed by 



Pope Paul VI will exert influence in our 

continent deserves a careful analysis. Our 
experience indicates that the Latin Amer- 
ica woman's individual behavior will be 
affected little or nothing at all. In Chile, 
for example, after and before the publica- 
tion of the "Humanae Vitae" encyclical, 
80% of those women requesting contracep- 
tive devices declared themselves to be 
Catholic. The true influence of the 
encyclical is being felt in the governments, 
as well as in the extreme left revolutionary 
movements, since these have a subject for 
debate. 

The encyclical frightens governments 
elected by popular will and does not let 
them act, since the official church and 
the conservative parties are opposed to any 
birth control action. If the government 
happens to be in the hands of military, 
the pro-natalistic policy of the encyclical 
coincides completely with the ideas sup- 
ported by Latin American militarism, 
which thinks of the woman as a soldier- 
producing machine and victory in war as 
achieved by number. Undoubtedly, our 
militarists forget the two last Israel-Arab 
wars. 

With respect to the extreme left, the 
impact of the encyclical is even more in- 
teresting to observe. The groups influenced 
by Marx in Latin America, or at least the 
ones calling themselves Marxists, have held 
the view that Marx and Malthus are two 
antagonistic thinkers. They maintain that 
the demographic problem does not exist, 
but only a problem of distribution of 
wealth; for them, birth control is an in- 
vention of American capitalism to keep 
Latin America subjugated; they have 
stated that the growth of our population is 
the only solution to achieve a change in 
the worn-out capitalistic structures. Paul 
VI on pronouncing himself an opponent 
of birth control by artificial means, is in 
favor of a pro-natalistic policy, which 
makes possible the dialogue between the 



8 



THE MARY SCOTT NEWBOLD SYMPOSIUM 



Church and the Latin American Marxist 
groups. 

This sui generis and extremely home- 
made interpretation of Marx contradicts 
Urlanis (3), doctor in economic sciences of 
the Soviet Union, who stated in the Con- 
gress held in Sydney in 1967 that "the idea 
widely divulged in the world literature 
that Marxism is against birth control is 
false. Such an idea is denied in many 
opinions written by Marx, Engels and 
Lenin, and because of this fact birth con- 
trol is widely practiced in the Soviet 
Union." The same author adds, "The 
countries of the Third World must have a 
favorable policy towards family planning 
and the small si/e family system; otherwise, 
they will face unemployment, which 
means more consumption than production 
and therefore a diminishing chance to im- 
prove the level of living." If such is the 
official word of a Russian Marxist author- 
ity, why does Latin American Marxism 
hold just the opposite? We cannot find any 
explanation other than a strategy to take 
over power. The uncontrolled increase of 
our population will bring about (as the 
Soviet economist stated so well) unemploy- 
ment and a deterioration in the standard 
of living, and these factors will be the best 
allies of a revolution directed toward 
destroying capitalistic structures. 

We have adverse factors even in the 
medical sciences themselves. The methods 
for artificial birth control we know today, 
although they are better than twenty years 
ago, are still far from perfect; conse- 
quently, their deficiencies invite scientific 
research to produce improvement, which 
could make possible the use of 100% reliable 
and efficient methods. 

Experience with hormonal contracep- 
tives taken orally in Latin American is 
only favorable among groups of a high 
cultural level and duly motivated. Among 
groups where poverty and illiteracy are 
predominant, the percentage of failure per 
100 year-women of observation has reached 



32% (4). We do not have information con- 
cerning the use of injectables. 

Our own experience (Figure 3) with 
intrauterine devices, the most advisable 
method for Latin American communities, 
shows a relatively greater efficiency among 
younger women. 

The influence of parity can be seen in 
Figure 4, a study of 8,170 women observed 
up to 36 months from the time of inser- 
tion of the Lippes loop. From such a 
study it can be concluded that greater ef- 
ficiency of the IUD is obtained in the 
woman older than 30 years and who has 
had more deliveries. The protection we 
can offer to women aged 20 to 30 years is 
relatively less, and certainly for the nul- 
liparous younger than 20 years of age the 
efficiency must be even smaller. 

Those who advocate the legalization of 
induced abortion find the best argument in 
the relative efficiency of our present birth 
control methods; the legal induced abor- 
tion is undoubtedly an efficient resort to 
lessen the harm done by the abortion per- 
formed by unskilled hands and useful as a 
method of birth control. Although its cost 
is high, it should be accepted until we can 
dispense more efficient contraceptives than 
the ones being used at present. 

We who are working in birth control 
have against us social factors represented 
mainly by the heritage of a pro-natalistic 
policy practiced by our native population 
for five centuries. We have against us the 
frustration and defeatism which results 
from poverty without hope. We have 
against us the militarism, which inspires 
the governmental policies of a good many 
countries. We have against us the official 
opinion of the Vatican hierarchy, which 
introduces fear in many governments. We 
have against us the Marxist left, which 
changes its doctrine hoping that the condi- 
tions produced by the demographic ex- 
plosion will lead them to power. Finally, 
we have methods of fertility control with 
relative inefficiency and the legal prohibi- 



POPULATION AVALANCHE 



9 



tion to practice abortion, except when the 
mother's life is in danger. 

If Latin America is looked upon as a 
whole, what has been done up to now can 
be characterized by two conditions: too 
little and too late. 

In the presence of such a situation, can 
it be expected that vast regions of Latin 
America will be saved from the same 
disaster affecting India nowadays? I am 
still optimistic, and my answer is yes, it 
can. It is true that we have adverse factors 
which are almost insuperable, but based 
on the experience of four years of work in 
Chile, as well as on the observation of what 
other countries have done, we must recog- 
nize that we have a factor in our favor. 
This is the demand for contraceptive 
services by the Latin American woman 
when she has the opportunity to know 
about such methods. The woman, the 
most responsible being of our society, 
constitutes our support and our faith in 
victory; her response justifies our struggle. 
Whenever a well-directed educational pro- 
gram offers contraceptive services, accept- 
ability exceeds possibility of service. 

PERCENTAGE OF WOMEN IN USE OF LIPPE5 
IUD AT THE BEGINING OF EACH PERIOD OF 
OBSERVATION UP TO THE END OF 36 MONTHS 
ACCORDING TO AGE AT TIME OF INSERTIONS. 




1 1 1 1 1 1 r- 

3 6 12 18 24 30 36 

MONTHS OF OBSERVATION 

Fic. 3. 



PERCENTAGE OF WOMEN 20 29 YEARS OLD 
IN USE OF LIPPES IUD AT THE BEGINING 
OF EACH PERIOD OF OBSERVATION UP TO 
THE END OF 36 MONTHS ACCORDING TO 
PARITY. 




1 1 1 1 1 1 |— 

3 6 12 18 24 30 
MONTHS OF OBSERVATION 
Fic. 4. 



In Chile, a permissive governmental 
policy has functioned within the structure 
of the National Health Service. Today, 
family planning is part of the mother-child 
care services, and the experience we are 
having induces us to state that the woman 
is receptive to education and advising 
whenever the doctor offers contraceptives 
and especially when she knows that doctors 
are also willing to take care of her new- 
born child. Integrated health actions will 
be able to bring down natality to a com- 
patible level with our production; if such 
policy is generalized and intensified, then 
Latin America could normalize its family 
and live under the western social norm of 
responsible parenthood. 

What we are stating can be evidenced by 
the results we have obtained in the western 
district of Santiago, which has an approxi- 
mate population of 130,000 women in 
fertile age. During the first four years of 
family planning program, 36,000 women 
have accepted the use of contraceptives. 



10 



THE MARY SCOTT NEWBOLD SYMPOSIUM 



This has meant that illegal abortion has 
decreased to 70% of the figure registered 
for 1964; the birth rate, which in 1964 was 
37.4, has decreased to 28 per thousand, 
still too high, but significantly lower than 
what it was. 

Finally, I wish to say that if the struggle 
against a high birth rate does not go along 
with an effective economic development, 
the victory that could be obtained would 
be ephemeral, the frustration produced by 
poverty could easily destroy responsible 
parenthood, and the family would revert 
to uncontrolled population growth and its 
vicious circle of hunger and death. The 
developed countries have, at present, his- 
torical responsibility. It is impossible for 
Latin America to stand alone against 
demographic explosion and to achieve its 
economic development. 

We are personally involved in this strug- 
gle, but, as we analyze the situation more, 
we understand better what that politician 
said: Latin America's take-off toward de- 
velopment can be done with two wings — 
family planning and economic develop- 
ment. But under the present circumstances 
it is too late to think of having our own 
wings; these have to be borrowed. If this 
does not happen, those who are living in 
developed countries will observe the hun- 
ger of those who did not get necessary help, 
given in time to adapt themselves to a 
world different from the one in which only 
muscle was able to produce energy and in 
which only death freed them from an ex- 
cessive population. 

(Dr. Mastroianni) Thank you, Dr. Viel. 
Dr. Viel has reviewed some of the economic 
and social forces which influence popula- 
tion growth in Latin America and he has 
brought to us the sad fact that in the 
Communist world and in Latin America, 
family planning is not generally accepted 
for reasons which are difficult to under- 
stand. 

He has also indicated that in Latin 
America generally, the hierarchy of the 



Church has not joined hands with the 
hierarchy of the churches in Austria, 
France, England, Canada, Belgium, The 
Netherlands and in one or two states in the 
United States where the conscience is 
looked upon as the court of last resort in 
this matter. 

Finally, he has pointed out that at this 
point in time we do have methods with 
which we could make considerable impact 
on population growth in Latin America. 
His own beautiful study with the intra- 
uterine device is one example of this. 

We will now ask Dr. Alan Guttmacher 
to review the status of the population 
avalanche in the United States. 

The Population Avalanche 
in the United States 

(Dr. Guttmacher) President Wood, Mr. 
Chairman, it's a great privilege to talk in 
this institution that has such a rich history 
and to stand in front of the portrait of 
Benjamin Rush. 

Dr. Viel gave us an excellent picture of 
the situation in Latin America and I only 
hope that I will be equally adequate to 
present the situation as I see it in our own 
country. 

I would like to remind the physicians 
present that the first doctor in America to 
become interested in the matter of family 
planning was a rather strange and perhaps 
brilliant man named Charles Knowlton, 
who was born in 1800 and died in 1849. He 
was graduated from the Dartmouth Medi- 
cal School. I say he is strange because, 
among other things, when he was studying 
anatomy, he wanted to have his own 
cadaver; he exhumed a friend and gave 
him part of the bedroom which he occu- 
pied during the month of January. He 
shared his quarters with the dissected 
specimen. Finally, the situation was dis- 
covered by the police and Knowlton was 
put in jail for two months for illegal dis- 
section. I think you will grant he was no 
follower of rules. 



POPULATION AVALANCHE 



11 



He became very much interested in ob- 
stetrics and in his part of New England 
developed an extensive obstetrical practice. 
During the course of this practice, he 
realized that a great deal of hardship 
accrued from unwanted pregnancy. 

He found America very ignorant about 
contraception and therefore in 1832 wrote 
a 75-page brochure called, "The Fruits of 
Philosophy," or "The Good Companion of 
the Married Couple." The book was writ- 
ten anonymously but apparently it was 
discovered later than Knowlton had been 
its author. He was rewarded by a $50 fine 
in Tottenham and three months in jail in 
Cambridge, Massachusetts, at hard labor. 

The book was modern in its contents in 
that he brought forth the urgent need for 
family planning and tried to answer the 
objections of those who would oppose its 
use. He raised the point as to whether 
or not increased knowledge of family plan- 
ning would be likely to increase promis- 
cuity and came to the conclusion that it 
would not. 

The method of family planning which 
he advocated in the book was the post- 
coital douche which he apparently had 
found in Aetios written some 1200 years 
before. He added a local note to its 
application. Since he was writing for a 
New England populus where indoor plumb- 
ing was apparently not the rule, he advo- 
cated not only that alum be put in the 
douche but some spirits be added as well 
to prevent it from freezing. He was a prac- 
tical man in addition to being a crusader. 

Knowlton was the earliest American 
physician to become concerned with con- 
traception, but other luminaries stand out. 

I always like to remind physician au- 
diences that the great Dr. Abraham Jacobi 
in 1912 made the matter of family planning 
an important paragraph in his inaugural 
address as President of the American Med- 
ical Association. 

There were local physicians all over the 
United States who were interested in birth 



control and the birth control movement. 
You had Dr. Dewees in your own commu- 
nity, and at a later date Stuart Mudd, 
Joseph Stokes and others, but as a whole 
until relatively recently, the medical pro- 
fession has been very resistant to involve 
themselves in the matter of family plan- 
ning. 

I have tried to think why the medical 
profession should have been resistant and 
I'm not sure I know all the answers; how- 
ever, I should like to suggest several. 

One is that in medicine we are immedi- 
ately and repeatedly taught the importance 
of preserving life. It is probably the main 
tenet of our creed and therefore the doctor 
may have had some difficulty in making 
the intellectual synapse between saving 
and preventing life. He didn't realize that 
by preventing life, perhaps he was saving 
life as well. 

In the second place, we had been taught 
the fact that the doctor should not do any- 
thing about which he is uncertain. 

The Latin phrase, non nocere, do no 
harm, was emblazoned on the walls of the 
Lying-in Hospital in Chicago, facing the 
stool upon which the obstetrician sat 
when he was to do a forceps. From time 
immemorial the medical attitude has been 
that if there is doubt, don't do it. 

In other words, in medicine, a sin of 
omission is not as great a sin as a sin of un- 
wise commission. 

In the third place, the doctor did not 
want to enter the area of controversy par- 
ticularly when there were such great reli- 
gious overtones as there were decades ago 
about the problem of birth control. The 
doctor who worked in the early Planned 
Parenthood clinics was even refused a 
staff position in Catholic hospitals; it was 
that strong a prohibition. 

Fourth, in the main, the doctor in Amer- 
ica has not been a leader in social chanse 
and progress. We have been among those 
who follow rather than those who lead. 

Finally, perhaps the doctor took it for 



12 



THE MARY SCOTT NEWBOLD SYMPOSIUM 



granted that because he knew birth control 
his patients were equally conversant with 
it. 

At all events, it is quite clear that the 
American birth control movement does 
not stem from medicine. It stems from 
early twentieth century feminism. Margaret 
Sanger, who actually established the Amer- 
ican movement and made of it such a vital 
and viable thing, was not primarily inter- 
ested in it because of birth control but 
simply as an important vehicle to raise 
the status of woman, to try to emancipate 
her from sexual servitude under which 
she served at that time. 

The American birth control movement 
has a great deal to thank Mrs. Sanger for; 
had it not been for her brave obstinancy 
and extraordinary talent, the movement 
certainly would not be where it is today. 

It is probably unnecessary to mention 
to so intelligent an audience that Mrs. 
Sanger opened the first birth control 
clinic in the United States on October 16, 
1916, in Brownsville, a slum area of Brook- 
lyn. 

As you may recall, in the first week she 
could not recruit a physician to staff the 
clinic because it was so hot a topic that 
physicians were afraid to traffic with a med- 
ical activity of such uncertain virtue. So 
during the first week, Mrs. Sanger and her 
sister took the history of 464 potential 
patients who came to the clinic to seek 
birth control advice. Mrs. Sanger took the 
histories so that, when she was able to re- 
cruit a physician, there would be less time 
lost in giving birth control service. You 
probably know that ten days later a police- 
woman disguised as a patient came in, had 
her history taken, bought a small pamphlet, 
"Family Limitation," which Mrs. Sanger 
had written on birth control, and, after 
she had stuck it in her handbag, blew her 
whistle and the cops came in and Mrs. 
Sanger, her sister and the records promptly 
went out. Mrs. Sanger and her sister went 
to jail and the records made a great bon- 



fire at the intersection of two important 
Brooklyn streets. 

Since then, the American medical pro- 
fession has become deeply involved in birth 
control. Physicians like Dr. Robert Latou 
Dickinson, one of our eminent medical 
leaders, and others had great influence on 
this. My own revered chief, Dr. J. Whit- 
ridge Williams at the Johns Hopkins, was 
not unimportant in having the medical pro- 
fession accept birth control as part of nor- 
mal medical care. 

I remember in Baltimore, where I was a 
resident, when we established the first birth 
control clinic. It was established by four 
great professors of the Johns Hopkins, but 
it was considered unwise to establish it 
within the precincts of the hospital, and 
therefore the first birth control clinic was 
five blocks away from the hospital at 1029 
North Broadway. Thus, in 1927 the corri- 
dors of the great and sacred Johns Hopkins 
remained uncontaminated by birth control. 
The same men ran the birth control clinic, 
but not under the same roof. After two 
years, seeing that nothing extraordinary 
happened, in 1929, we opened a birth con- 
trol clinic within the confines of the Hop- 
kins Hospital. 

The fact that many, many U.S. hospitals 
have birth control clinics is a relatively new 
development, for contraceptive service was 
very slowly accepted by American hospitals. 
They had no feeling of responsibility either 
to their patients or to the education of 
their staffs. This retarded the progress of 
birth control in this country tremendously. 

What is today's American scene? There 
has been a tremendous development of the 
Planned Parenthood movement in this 
country so that currently there are 164 
cities with affiliates of Planned Parenthood 
World Population. Thirty-two are what we 
call educational affiliates. These do not 
operate clinics but stimulate and intellec- 
tualize the community about family plan- 
ning and cooperate extensively with setting 
up birth control facilities in existing hos- 



POl'L' I .ATION AVAI.AXCH F. 



pitals and health departments. In the other 
132 cities, we operate some 480 clinics 
and see about 350,000 women in the course 
of a year, 275,000 of whom are poor or near 
poor and within the group called medi- 
cally dependent. 

Today, unlike yesteryear, there are other 
organizations furnishing birth control to 
needy patients. Health departments in the 
United States have taken up the cause and 
each year more counties and more states 
are involving their own health departments 
in the service of family planning. 

It is estimated that in the year ending 
June 30, 1968, the last date for which 
we have an estimate, 350,000 indigent 
women were given contraceptive care by 
U.S. Health Departments and another 
250,000 by hospital clinics. 

It is felt, and this is a rough estimate, 
that approximately 875,000 medically in- 
digent women are getting birth control ad- 
vice either through planned parenthood or 
through the health department or hos- 
pital of their areas. 

No doubt, private physicians give birth 
control advice to many indigent patients, 
some on Medicaid plans and other reim- 
bursement schemes. The volume is very 
difficult to estimate, but just to make our 
figures come out neatly, we will say 125,000 
patients in 1967 received such service from 
the physician. 

If that is correct then, one million medi- 
cally indigent women in this country are 
receiving birth control through public 
sources, with the private physician receiv- 
ing some type of public reimbursement. 

Is one million the number that need 
such service? It is not thought to be. Ac- 
cording to census data for 1967, there were 
7.9 million women of the medically de- 
pendent group of reproductive age in this 
country. It was assumed by some other 
statistical maneuver that 2.6 million were 
either pregnant or seeking pregnancy, which 
left 5.3 million women of the medically 
dependent group of reproductive age who 



are not seeking pregnancy or pregnant. 
This then would mean that of one million 
served, we would have a deficit of 4.3 mil- 
lion women yet in this country who remain 
unprovided for. 

These figures are estimates made by the 
Health Statistics Bureau of the U.S. Govern- 
ment under Dr. Arthur Campbell and by 
my own group. They are very rough and 
may not be accurate, but nevertheless, they 
point out that in America there still is 
a large reservoir of medically indigent 
women who are not yet receiving modern, 
effective contraception. 

It does not mean these women are not 
using any contraception, because we are a 
nation of contraceptors. As Dr. Berelson 
pointed out at our breakfast meeting this 
morning, probably some 90% of fertile 
Americans not seeking pregnancy use some 
attempt to limit their fecundity, but cer- 
tainly there is a great difference in the ef- 
fectiveness of the methods used by those 
who are of the affluent, educated group 
and those methods used by the uninstructed 
and less affluent group. Therefore, our 
task is not necessarily to persuade the 
women yet unserved to use birth control, 
but to use better birth control. 

There have been many studies on desired 
U.S. family size; according to the studies, 
it has been shown that the poor and near 
poor desire slightly smaller families than 
those in the non-poor group. These figures 
show a desired family size of about 2.9 
children by the near poor and the poor and 
3.3 children by the non-poor group. If such 
figures are reasonably accurate and I as- 
sume they probably are and we were able 
to give the poor the same effective birth 
control which is available to the affluent, 
we would see a decrease in their family 
size, and probably equality between the 
family size of the affluent members of our 
community and of the poor and near- 
poor members. 

Currently there is quite a difference in 
the fertility rate between the two groups. 



14 



THE MARV SCOTT NEWBOLD SYMPOSIUM 



I am quoting figures collected between 
1960 and 1965. In that period, the poor and 
near poor had a fertility rate of 153, which 
means number of viable pregnancies per 
thousand women of fertile age, 15 to 45, 
while the non-poor had a fertility rate of 
98. There is then a gap of 55 points be- 
tween the fertility rate of the two groups, 
the poor and the middle class. 

Dr. Arthur Campbell has published data 
on the estimated number of unwanted 
children born in this country each year. 
Families were surveyed to find our whether 
or not the last child was a wanted child. 
An astonishing figure was found, even with 
the child crawling around the mother's 
apron strings. Over 25% of last children 
born in this country when the survey was 
made were unwanted children. 

On this basis, Dr. Campbell estimates 
that of four million births, which was the 
average in the 1960-65 period, 850,000 
were unwanted, that is, 23%. 

There was a difference between those 
in the non-poor status and those in the 
poor and near-poor group. Forty per cent 
of the last children born to the poor and 
near poor are unwanted, while only 14% 
of those born to the non-poor group are 
unwanted. 

All this leads me to conclude that we 
cannot become complacent and say since 
Americans are a nation of contraceptors 
we have no fertility problem. We obviously 
have a problem. We have a great prob- 
lem with vast unmet needs. The question 
is how best to serve these needs. 

It is obvious that there must be complete 
cooperation between all birth control fa- 
cilities. In this community, you have 
many interested groups. You have the 
Planned Parenthood group. You have the 
Better Family Planning group. You have 
many hospitals with clinics. You even have 
Catholic hospitals, I believe, with rhythm 
clinics. 

I understand there is also beginning 
involvement of the Health Department. 



What we need to do in all America is to 
try to mobilize the full potential. At the 
national office in New York, under grants 
from the Kellogg, Rockefeller, and Ford 
Foundations as well as several other lesser 
foundations, there has been established the 
Center for Family Planning Program De- 
velopment. This group of professionals 
will take city after city and try to analyze 
the birth control facilities now operating 
within the particular community. 

We are working currently in Dallas and 
have worked in Los Angeles. I don't know 
which is the next city selected for such in- 
tensive analysis. It may be your own. An 
attempt is made to assess how much of 
the birth control need is being met in the 
particular community and to find out what 
the existing facilities are to meet the need. 
The attempt is made to stimulate existing 
facilities to liquidate the unmet need ra- 
ther than to open up new Family Plan- 
ning clinics under Planned Parenthood 
auspices. 

The goal is to have every hospital con- 
duct a vigorous, vital, productive clinic, 
not a clinic that simply makes obeisance 
to the fact that it is doing a little family 
planning work, but a clinic which is vital, 
interested and organized for the specific 
purpose, a clinic which meets not only on 
Thursday afternoon but at night or on 
Saturday morning or Saturday afternoon 
if the need exists. It is essential that we 
stimulate existing facilities in the whole 
health field, that is, Health Departments 
and hospitals, to do the task and do it 
with real spirit. 

To meet the unmet need in some com- 
munities, we will still have to open new 
birth control clinics operated by Planned 
Parenthood. This is regrettable. Recently 
I was in Lansing, Michigan, which is the 
home of a huge university, Michigan 
State. Perhaps it is known best for its foot- 
ball team although it is an excellent school. 

They have 40,000 students, 23,000 men 
and 17,000 girls. The only family planning 



POPULATION AVALANCHE 



15 



service given in that community is given 
by the Health Department, which in fact 
has just started. They see about 500 pa- 
tients per year and because of political 
considerations cannot take unmarried 
coeds. The University feels no responsibility 
toward the unmarried coed and her birth 
control problem. Lansing is a very con- 
servative medical community. In addition, 
the doctors are very busy. I talked to some 
of the obstetricians and they made it quite 
clear that they would not welcome an in- 
vasion of coeds in their offices. Here then 
is a large segment of the population un- 
served by existing medical facilities and is 
not likely to be. It may very well be that 
we will have to open a Planned Parenthood 
clinic in this community largely to serve 
unwed college students. 

They certainly deserve the service and 
need it badly. I see no point in discrimi- 
nating against the middle class simply be- 
cause we are intent on serving the poor. 

If there is an unmet need among the 
middle class, it must be served in some 
way. In the area of birth control, we must 
be realistic and try to supply the need 
wherever the need exists. 

There are many portents to make us 
realize that from the point of view of con- 
ception control all is not well in America. 
I need not remind you that we shall have 
300,000 illegitimate children born this year. 

The illegitimacy rate is up to 8.7%. 
This is not excessively accurate because a 
lot of births that are illegitimate are re- 
gistered as legitimate, so that the rate of 
8.7 is a minimum figure. Then, too, one- 
sixth of brides are pregnant when married 
in this country. 

If we consider all children illegitimate 
who are born less than nine months after 
marriage, it would increase the illegitimacy 
rate to about 25%, taking the 8.7 
and the 16% and adding them. By 
this definition any pregnancy leading 
to birth initiated outside of marriage is 
illegitimate. Perhaps this should be termed 



the social illegitimacy rate in contrast to 
the legal illegitimacy rate. 

There are an estimated one million il- 
legal abortions done in this country each 
year. This figure is a gross estimate; it 
may be greater, it may be less, but it's 
a vast number. I think on these two indices, 
illegitimacy and illegal abortion, we are 
forced to admit that we are not doing too 
good a job with birth control either among 
the poor or the rich. 

The facts proving reproductive chaos 
present a challenge to all of us. Each of 
you is interested in family planning or you 
would not be here. This presents a chal- 
lenge to each of you individually, to think 
this through and see how these multiple 
problems can best be met: the problem of 
illegitimacy, the problem of forced mar- 
riages, the problem of teenage divorces, and 
the fact that illegal and legal abortion are 
both highly discriminatory. All of this socio- 
medical pathology must be put into proper 
focus; it exists and can not be swept under 
the rug. 

In addition, we must take full cognizance 
of the fact that our work among some 
militant minority groups, is considered 
genocidal. They charge that what we are 
doing is not really trying to give a better 
family life to the less privileged segments 
of the community but trying to retard the 
numerical growth of ethnic minorities. 

This was first brought to my attention 
five or six years ago when I was lecturing 
at the University of California. For the first 
time in a long life I was picketed, and this 
fascinated me. I was picketed by a group 
called EROS, so I went down and chat- 
ted with the pickets who were very intelli- 
gent-looking black men. EROS means 
Endeavor to Raise Our Size. The group 
said that there had been no Catholic 
president until there were 40 million 
Catholics in America and since there were 
then only 21 million Negroes they had to 
double their numbers as rapidly as pos- 



16 



1 I IK MARY SCOTT NEW BOLD SYMPOSIUM 



sible. They protested the work of PPWP as 
a form of genocide. 

You know full well that the program of 
family planning is purely voluntary. Coer- 
cion is and must continue to be left out 
of it wholly, totally and completely. 

Let me cite a recent episode. Three 
young women were brought before Judge 
Perry Bowen in Prince George County 
in Maryland because between the three 
they had had eight illegitimate children. 
Judge Bowen decreed that unless they 
practiced family planning, he was going 
to take their children away. This was the 
edict from the bench. 

This is hardly the best way to intro- 
duce family planning into America. You 
do not discriminate against people and 
single them out because they happen to be 
poor and unfortunate enough to have il- 
legitimate children and make them practice 
family planning by an order from the 
bench. We defended these young women by 
presenting an amicus curae brief. In the 
Court of Appeals the defense was upheld 
by a six to one decision. If proof is needed 
that our philosophy is neither coercive 
nor genocidal, this case ought to prove it. 

In America, birth control should be ac- 
cepted by the individual because she or he 
thinks that it is important and right for 
their family pattern. 

It is time that we come to grips with 
two methods of family planning which we 
have a tendency to skip over in this country. 
One is abortion. I doubt that any of you 
is satisfied with the archaic, punitive, 
medieval law which now exists in your 
state and in mine which permits abortion 
to be done only to preserve the life of the 
mother. 

Almost all realize that liberalization of 
the abortion law is absolutely essential to 
permit the practice of good, honest medi- 
cine, not hypocritical medicine, but honest 
medicine. 

The question is how extensively should 
we liberalize the law. Some people say we 



should have abortion on demand. I am 
sure that your children, certainly your 
grandchildren, will live in an America 
where there is abortion on demand. 

But I think currently lay America is not 
ready for it; I am not sure the medical pro- 
fession is ready for it, nor do I think I am 
ready for it. I am ready for it in the dis- 
tant forty years, but I'm not ready for it in 
the current situation. However, I am to- 
tally dissatisfied with the American Law 
Institute statute because it allows abortion 
only to preserve life or health, when there 
is likelihood of a child being born mal- 
formed or retarded, or evidence of sex 
crime, rape or incest. 

The states that have put the A.L.I, stat- 
ute into operation have found that it has 
done little to increase the incidence of legal 
abortion. In Colorado, the legal abor- 
tions done before the bill was put into oper- 
ation were 51 per annum and after the bill 
had been in operation for one year there 
were 407. 

We find that in California the legal 
abortions before the bill was put in oper- 
ation were 500, and after the bill has been 
in operation for a year, about 6,000. It is 
estimated that there are 80,000 illegal abor- 
tions in California annually. Subtracting 
6,000 from 80,000, leaves still a huge sur- 
plus of illegal abortions, 74,000. Who is the 
surplus? A lot of the surplus are unmar- 
ried children, children less than 16 years 
old. 

I cannot believe that it contributes to 
the welfare of the child or the community 
to compel a child of less than 16 to bear 
an illegitimate child or seek the services of 
an illegal abortonist. 

To me, either choice is insane and I see 
no justice in it. It stems from punitive, 
puritanical reaction which has no basis in 
logic. Furthermore, a lot of the people who 
patronize the illegal abortionist are women 
who have had four or five children. I 
contend that any woman who has borne 
four children should certainly be in the 



POPULATION AVALANCHE 



17 



ideal position to determine whether a fifth 
child w ill be an asset to that home. 

Is a doctor, judge, or social worker in a 
better position to decide that a fifth child 
will be ail asset to the home than the 
mother who has already borne four? 

I could go on and spell out how Pennsyl- 
vania should liberalize its abortion law, 
but unfortunately you will end up no 
doubt getting a bad law like they have 
gotten in Colorado, North Carolina, Geor- 
gia and California. 

The only state that has passed a humane 
law is my native state, Maryland. Mary- 
land has removed abortion from the penal 
code and put it under the Medical Practice 
Act. Since the passage of the new statute, 
two of Baltimore's hospitals with courage, 
the Johns Hopkins and the Sinai, are doing 
a relatively large number of legal, justified 
abortions. 

Furthermore, I think we fail to use steri- 
lization correctly. The incorrect use of ster- 
ilization is what many of the legislatures 
of the Southeast are attempting to do, to 
make sterilization mandatory after a woman 
has had two illegitimate children. 

W herever I go in the South, I find such 
a law is before the legislature, and it 
takes a lot of fighting to keep such a harsh, 
discriminatory law from being passed. 

Sterilization should always be, as far as I 
can see, a purely voluntary procedure 
sought with enthusiasm by the patient. 

We need to change the attitude of the 
medical profession toward sterilization. 
I was in Jacksonville, Florida, yesterday 
and I heard sterilization discussed. In 
Jacksonville, doctors are even afraid to 
sterilize a woman after she has had six 
living children. Why, I ask? Well, it's the 
rules of the hospital. Well, how do you 
change the rules of the hospital? Well, the 
staff makes the rules of the hospital. How 
do you make the staff understand that 
three or four living children would present 
a radical indication for voluntary steriliza- 
tion? 



Well, we'll have to have a campaign to 
do it. What has to be done is to gird up 
the loins of some doctors who'll take the 
ball, carry it and score the goals. 

I hope I've given you some insight into 
what's good and what's bad about the 
American birth control scene. I would 
like to point out one fact: the birth rate is 
doing something very interesting. It has 
come down very sharply, so that it has 
fallen from 25.5 per 1000 in 1957 to 17.6, 
the estimated rate for 1968. We have had 
a downward birth rate curve in America 
for a long time; Dr. Berelson says for 150 
years. 

And the curve is still going down. Cur- 
rently it is the lowest birth rate we have 
had in our history. It probably is not all 
due to modern birth control because dur- 
ing the depression years, when we did not 
have the IUD or Pill, our birth rate went 
as low as 18, but I think that the modern 
contraceptive method has contributed to 
the current decline. The birth rate is 
lower for two reasons. Despite the fact that 
the marriage rate has gone up, the birth 
rate has gone down; the number of first 
births has gone down. Americans are post- 
poning the first child and also having 
fewer more than 4-child families. These 
two factors are bringing the birth rate 
down, at least temporarily. 

Are these people postponing their chil- 
dren and going to begin to go into produc- 
tion soon? I have a feeling they will; then 
the birth rate is likely to go up again. 

(Dr. Mastroianni) Thank you, Dr. Gutt- 
macher. Dr. Guttmacher has put the birth 
control movement in the United States in 
its historical perspective and has brought 
us up to date on some of the issues in 
modern American society. He has properly 
emphasized the importance of personal 
freedom of choice in this matter, and, 
finally, has touched on abortion and 
sterilization, two issues which deserve care- 
ful consideration. 

We have asked our third panelist, Dr. 



18 



THE MARY SCOTT NEWBOLD SYMPOSIUM 



Bernard Berelson, to discuss the popula- 
tion avalanche as reflected in world terms. 

Population Problems in the 
Developing World 

(Dr. Berelson) Anyone who gives even 
cursory attention to public affairs these 
days cannot fail to know that there is a 
population problem in the developing 
countries. The so-called "population ex- 
plosion" featured in dramatic headlines is 
high on the list of topics most often viewed 
with alarm. What exactly is the nature of 
the population problem? What are its 
origins and what are its consequences? 
What is being done about it? And what 
does it have to do with the medical com- 
munity? 

Let me begin by speaking to a number 
of popular misconceptions on this matter. 

Misconception No. 1 is that human num- 
bers themselves are overwhelming us. 
However, the enemy is not a number but 
a rate. According to the latest United 
Nations figures, the population of the 
world is now growing at the rate of about 
2% a year. That rate may seem to be 
small, but the fact is that the world's popu- 
lation has never before grown at such a 
pace for any extended period of time, and 
the consequences can be severe. This is 
literally a unique situation in human 
history. 

The population of the world is now 
about 3.5 billion, and we are adding over 
65 million people every year (about the pop- 
ulations of England, The Netherlands, and 
Switzerland combined), or approximately 
1.25 million people a week. At 2% a year, 
a number doubles in about thirty-five 
years, so at the turn of the century the 
population of the world will be 7 billion 
if the present growth rate continues. It 
took all of human history up to about 1850 
to produce a world population of 1 billion; 
it took only seventy-five years for the 
second billion, and thirty-five years for 
the third. At the present rate it is taking 



only about fifteen years for the fourth 
billion, and it will take only ten years for 
the fifth. These are striking figures. What 
they indicate is that the world cannot sus- 
tain such a growth rate for very long. Over 
the long run, as a recent report by the 
National Academy of Sciences put it, 
"either the birth rate of the world must 
come down or the death rate must go 
back up." 

Misconception No. 2, signalized perhaps 
in the very term "population explosion," 
is that the current unprecedented growth 
rate is caused by an increased birth rate. 
The opposite is the fact: it is caused by a 
decline in the death rate, a decline that 
has accelerated greatly since the end of 
World War II, particularly in the de- 
veloping countries. The decline is due to 
improved food production and distribu- 
tion, more effective social organization, 
and particularly, thanks to the medical 
community, to the mass application since 
World War II of modern public health 
measures such as vaccines, antibiotics, sulfa 
drugs, and the new insecticides. In other 
words, the world death rate has been re- 
duced largely because death control has 
been successfully exported from the de- 
veloped to the developing countries. As a 
result, the rate of population growth is 
now much higher in the developing 
world, that is, in that two thirds of the 
world (Africa, Asia, and Latin America) 
where the birth rate is over twice that of 
the United States or Western Europe. If 
all the countries of the world were listed 
in order of their birth rates and a line 
drawn at 30 per thousand per year, the 
differentiation between the developed and 
the developing countries is virtually com- 
plete. 

Hence, the burden of population growth 
falls where it can least be accommodated, 
and the politically dangerous differentials 
between the have and the have-not nations 
are thus sharpened by the most basic of 
life processes. It is no exaggeration to say 



POPULA1 ION AVALANCHE 



19 



that there are two kinds of countries in 
the world today: those with a high stand- 
ard of living and low fertility and those 
with a low standard of living and high 
fertility. 

Those misconceptions have to do with 
the nature and the cause of the problem. 
The next two have to do with the con- 
sequences. 

Misconception No. 3 is that population 
density is at the heart of the matter, or, in 
the popular phrase, that soon there will 
not be standing room on the earth. Given 
present birth rates, at some point in the 
distant future, of course, there will be no 
more room, assuming by that time man's 
ingenuity has not found a way of extend- 
ing the finite limits of this globe. At pres- 
ent, density does raise health questions as 
well as esthetic considerations, but under 
most conditions density is not closely re- 
lated to the problems of population expan- 
sion as is illustrated, for example, by the 
relative prosperity of crowded Hong Kong 
or for that matter of the large cities in the 
United States. In this regard, it is salutary 
for Americans to remember that the most 
densely populated areas in the world to- 
day include not only Japan, Java, East 
Pakistan, and The Netherlands, but also 
the eastern seaboard of the United States 
from Boston to Washington. 

Misconception No. 4 is a more serious 
matter: that we will not be able to feed 
the population anticipated for the next 
few decades. The experts differ on this 
subject. Some predict that the world will 
soon be in real trouble on this score, but 
others believe that we shall just be able to 
get by. At best, it appears that the race 
between people and food will be a close 
one. Modern improvements in technology, 
not only in agriculture but also in com- 
munications and transportation, perhaps 
will enable us to feed the projected in- 
crease in world population — not to feed 
them well but at least to keep large num- 
bers from starving to death as in the not- 



so-distant past. Large-scale famines, like 
large-scale epidemics, are now more amena- 
ble to control. People will not get a healthy 
diet, here and there some will die of mal- 
nutrition, and many major countries may 
have to depend on imported food. But 
more people will survive. 

That brings me by way of summary to 
Misconception No. 5, the underlying one: 
that the population problem is a matter of 
quantities. Quite the contrary, it is a mat- 
ter of human quality — of people with a 
decent chance at good health and nutri- 
tion, at literacy and popular education, at 
good housing and rewarding occupations, 
at individual opportunity and fulfillment. 
At bottom the problem is to keep the 
quantity of human life from diminishing 
the quality of human life throughout the 
world. What kind of population do we 
want, not how many: that is the real 
question. 

Thus the basic issue is very broad in- 
deed. It has to do with the entire social 
and economic development of the poorer 
countries. Such countries are now seeking 
to transform their traditional agrarian sub- 
sistence societies and become twentieth 
century nations. At best that is not an easy 
task, but it is made all the more difficult, 
perhaps prohibitively difficult, when it 
must be done with the additional burden 
of a heavy population growth. If the 
population grows at the rate of 2.5 or 3% 
a year, it takes the same rate of economic 
growth simply to stay even. In the develop- 
ing countries a very large part of the 
product is consumed daily in the struggle 
for immediate survival, and such countries 
are hard put to raise the national capital 
for .the factories, roads, fertilizer plants, 
irrigation networks and machinery that 
will yield a better life tomorrow. This is 
where the population pressure rubs. 

There are two other factors that are sel- 
dom appreciated as being important in the 
total situation. First, by virtue of the high 
birth rates, large proportions of the popu- 



20 



THE MARY SCOTT NEWBOLD SYMPOSIUM 



lation in developing countries are chil- 
dren. This situation requires that the 
countries invest substantial amounts in 
such social services as education and 
health. In many countries more than 40% 
of the population is under fifteen years of 
age, whereas this figure is more like 25% 
in the developed nations. Thus, develop- 
ing countries have not only a large overall 
growth rate to contend with but a large 
proportion of dependent youth as well. 

The second factor is the "effective per- 
sonal freedom" of couples throughout the 
world to determine the number of chil- 
dren they will have and when they will 
have them, in accordance with their own 
religious beliefs and personal preferences. 
Today, married couples do have that free- 
dom in law or in principle, but because of 
ignorance and poverty and because proper 
information and services and supplies are 
lacking, the poor people throughout the 
world are not effectively free in this re- 
spect. Ideally, the Indian villager should 
have the same effective right to control 
family size as the Main Line resident; yet 
since this right is so much taken for 
granted by us, we tend not to recognize 
how vital it can be to others. 

So over the next years, the populations 
of the developing countries will surely 
grow. There is hardly a realistic alterna- 
tive. The 500 million population of India 
and the 100 million of Pakistan and Indo- 
nesia, for example, will almost certainly 
double. The question is whether these 
countries can have sixty years in which to 
do so instead of twenty-five. Short of major 
catastrophe, no developing country will 
have fewer people than it has today. The 
question, then, is not whether there will be 
growth but rather whether the growth 
will be very fast or only moderately fast. 

As a solution to these problems, emigra- 
tion can be immediately ruled out. There 
are simply no facilities or funds for such 
mass movements as took place in Europe in 
the nineteenth and early twentieth cen- 



turies, no place for the far greater num- 
bers involved to go, no political atmos- 
phere for the forced migration that would 
be required, no time for such movement to 
take effect. Nor can we discontinue efforts 
to improve public health. Once death con- 
trol is available, it will not willingly be 
relinquished. If anything, that side of the 
equation will continue to decline as more 
and better public health measures are 
applied. Nor can the nations involved af- 
ford to wait for the natural process of 
economic, educational and medical de- 
velopment to result in a lowered birth 
rate, as it has in the West. There simph 
is not time, considering the rapidity with 
which modern medicine and public health 
have reduced the death rates in the de- 
veloping world. As noted earlier, popula- 
tion growth itself has now become a major 
obstacle to technological advance. The 
dilemma is poignantly real: population 
growth is so rapid as to prevent or retard 
the emergence of the very conditions that 
history shows to be capable of reducing 
growth rates through reducing birth rates. 

The solution then is to reduce the birth 
rate, and to do it reasonably soon. 
Throughout most of man's history, a high 
birth rate was necessary for survival of the 
community because the death rate was so 
high. Today, a high birth rate is contrain- 
dicated wherever people are reaching for 
the benefits of modernization. 

This state of affairs has increasingly been 
recognized by the governments of the de- 
veloping world, and in recent years some 
20 countries have established national pro- 
grams to bring family planning to their 
people. In the developing world today, 
about 65% of the people live in countries 
with such favorable policies. The move- 
ment began in Asia and has made most 
headway there; as a result, approximately 
80% of the developing population in Asia 
lives in countries that accept and en- 
courage family planning as against only 
20% in Africa (mainly in the northern 



POPULATION AVALANCHE 



21 



tier) and 15% in Latin America. Thus, 
attacks on the population problem have 
become a matter of governmental policy in 
developing countries in a remarkably short 
period of time. It is in fact difficult to 
think of another movement of such com- 
bined delicacy and magnitude that has 
made similar headway, and especially so 
when the apparent religious, political and 
cultural obstacles are taken into account. 

It is generally believed that once a 
favorable policy toward birth control and 
family planning has been established, the 
successful implementation and operation 
of a program depends upon three factors: 1., 
interest on the part of the people, 2., a 
suitable and acceptable contraceptive tech- 
nology, and 3., the organization to bring 
one to the other. Studies have shown that 
interest exists in surprisingly large meas- 
ure, even in the rural areas. With the de- 
velopment of oral contraceptives and 
particularly of the new intrauterine de- 
vices, the technological position is far 
better than it was only a few years ago, 
though major improvements are still 
needed. What many of the programs still 
lack is the third ingredient: an effective, 
vigorous, skilled organization to administer 
and conduct the program. Among other 
things, the underdeveloped world is un- 
derdeveloped in efficient administration, 
medical and otherwise. The important 
thing is, however, that throughout the 
world, progress in this area is now being 
made — in countries on the great crescent 
from South Korea, Taiwan, Malaysia, 
Singapore, Ceylon, India, Pakistan, Iran, 
to Turkey; the northern tier of Africa from 
the United Arab Republic to Tunisia and 
Morocco: in Kenya; in several of the 
Caribbean islands; and in a modified form 
in Chile and Colombia. And just re- 
cently, in some relatively favorable situa- 
tions such as in Taiwan, South Korea, 
Singapore and Hong Kong, family plan- 
ning programs have probably brought 
down the birth rate. 



I hope I have given you the impression 
that this is a rapidly moving field, for that 
is certainly the case. Almost all the de- 
velopments in national family planning 
programs have occurred within the past 
five years or so. Even so, there are several 
qualified scholars who believe that what 
is being done will fall far short of the mark 
and that much greater measures must be 
taken if the problem is to be met. 

If I do not miss my guess, we are in the 
foothills of a great world debate over the 
next years on population policy itself. It 
is already beginning in the United States, 
as some people contend that even this 
country cannot now afford a birth rate be- 
yond replacement. The Planned Parent- 
hood movement, historically based on the 
case for the wanted child, is itself now de- 
bating whether people should be dis- 
couraged on social grounds from having 
even the children they want. In some de- 
veloping countries with relatively severe 
population pressures, proposals are under 
discussion with regard to the liberalization 
of induced abortion, incentive programs 
that would pay people for the initiation or 
effective practice of contraception or for 
periods of non-pregnancy or non-birth, 
tax and welfare benefits and liabilities 
that would work in an anti-natalist direc- 
tion, shifts in social and economic institu- 
tions in order to raise the minimum age of 
marriage or promote female participation 
in the labor force or even shake up the 
family structure itself, and, finally, es- 
tablishment of involuntary fertility control 
in one way or another. As you can readily 
see, there are great issues for mankind in 
the developing debate on population 
policy — political issues, economic issues, 
medical issues, ethical issues. In this arena 
as in others, what was taken for granted 
only a few short years ago is increasingly 
being called into question. In fact, it is 
something of an irony that at the very 
time that the United Nations, after much 
travail, finally declared that the right to 



22 



THE MARY SCOTT NEWBOLD SYMPOSIUM 



effective family planning is a basic human 
right, some people are arguing that the 
world cannot afford that right and that in- 
dividual families must defer to the re- 
quirements of the society and the state. 

These problems weigh heavily on all of 
us, but this is an area in which medical 
people have a particular responsibility. 

First, the whole field of research on the 
physiology of reproduction, including re- 
search on efforts to intervene in that 
process, must be pursued more vigorously. 
Experience with national family planning 
programs in the past few years has made it 
clear that the contraceptive technology it- 
self is of critical importance for the success 
of such programs. A difficult technology 
will not work well; an easy technology is 
needed. With the oral contraceptive and 
the intrauterine device, the situation is far 
better today than it was a few years ago; 
but we are not yet near a satisfactory posi- 
tion in this regard. We need more basic 
knowledge of human reproduction and 
more sophisticated applications to the 
practice of contraception. 

Medical educators also have a training 
responsibility. In the United States, this 
responsibility extends not only to training 
the next generation of leadership for 
American medicine but also a large num- 
ber of students from abroad who will be- 
come the medical leaders in their own 
countries. To be successful, family plan- 
ning programs both here and abroad must 
rely upon the informed support and usu- 
ally the active leadership of the medical 
community. Indeed, such programs cannot 
succeed, perhaps cannot even exist, in the 
absence of medical enthusiasm for them. 

Given these circumstances, it would 
seem clear that medical education has a 
major responsibility in this regard — to pro- 
vide the basic training that will acquaint 
doctors with the problem and enable them 
to play their proper role. I take it as given 
that doctors will think those things pre- 
eminently medical that appear in the 



medical school curriculum. Yet, to some of 
us in the field, it has sometimes seemed 
as though the medical profession was pre- 
pared to face almost anything except the 
consequences of its own success in cutting 
down death rates throughout the world. 

When one moves from the individual 
doctor-patient level to a consideration of 
the far more complicated issues involved in 
the collective problem, it seems clear that 
the medical schools have definite service 
responsibilities in relation to family plan- 
ning programs. For example, working on 
the plausible assumption that at the time 
of delivery women would be particularly 
receptive to the subject of family planning, 
the Population Council has organized the 
International Postpartum Family Planning 
Program, with 26 large delivery hospitals 
in 20 cities in 15 countries, including the 
three largest maternity hospitals in the world 
and the second largest in the United States, 
handling about 340,000 delivery and abor- 
tion cases each year. Within the U.S., we 
are now seeking to extend this postpartum 
concept to programs with the American 
poor. A number of medical schools have 
affiliated hospitals in or near the so-called 
poverty pockets of our great cities. What 
could be more natural than to implement 
a strong family planning and associated 
maternal and child health program for the 
urban poor through the facilities of our 
major medical schools? Finally, the Coun- 
cil is collaborating on a study with the 
new International Institute for the Study 
of Human Reproduction, under the dis- 
tinguished leadership of Dr. Howard 
Taylor, to determine what it would take in 
funds, personnel, training and facilities to 
develop some forms of professionalized, 
institutionalized maternal care that would 
reach into the rural areas of the developing 
world and incorporate family planning 
along with prenatal and postpartum ser- 
vices. 

But the overriding responsibility for 
medical people is to become informed and 



POPULATION AVA1 \N( III 



23 



stay informed on an issue with such com- 
prehensive ramifications. Doctors arc not 
only doctors; they are community leaders, 
both here and abroad. One does not need 
much sense of history to observe that the 
medical profession has been largely re- 
sponsible for what is without question one 
of the greatest achievements of mankind— 
the elimination of illness and the prolon- 
gation of healthy life. Nor does one need 
much historical perspective to sense that 
these decades of the population problem 
have placed upon world medicine, and in 
a special way upon American medicine, the 
heavy responsibility of exerting leadership 
on the other side of the population equa- 
tion. There is the challenge, and there too 
is the opportunity. 

(Dr. Mastroianni) Dr. Berelson has pro- 
vided us with a learned discussion with 
major attention focussed on the world 
problem. He has pointed out that al- 
though we have a variety of means which 
allow for family planning, the motivation 
of the individual is all important. Al- 
though he espouses the concept that there 
surely should be individual choice, he pre- 
dicts that eventually we will come to some 
system where that individual choice can be 
pushed in the direction of fewer children 
in the individual family unit. 

Questions 

Dr. Guttmacher, you stated that you 
were in favor of personal free will as far 
as women desiring to allow pregnancies to 
go full term. And then shortly after that 
you opposed abortions on demand. On 
what basis do you object to them? 

(Dr. Guttmacher) The American public 
is not ready for it. All the polls show that 
no more than 20% of the lay public is in 
favor of abortion on demand and that even 
less of the medical profession approves. 
Thus, in the United States, abortion on de- 
mand is ahead of our times. That means 
we cannot hope to get such a permissive 
statute. Therefore, pragmatically, I think 



we ought to be realistic. Let's get a good 
law, since you won't be able to get com- 
plete freedom of choice. So, let us be 
politicians and put before our legislatures 
a humane law which some day, not too 
distant, we can sell to them. 

In Maryland, they've done a spectacu- 
lar job. Actually, what they have done is 
to remove abortion from the penal code 
and put abortion under the Medical Prac- 
tice Act. They have given doctors control. 
The doctors elected to put into operation 
the American Law Institute bill. The 
medical and chirurgical faculty of the 
State is allowing hospitals to interpret the 
A.L.I, law according to their own light, 
and therefore, a place like the Johns Hop- 
kins is doing a splendid number of legal 
abortions. 

Rut when you have the rules spelled out 
by legislators and they enforce the law as 
written and abortion is not taken out of 
the criminal code, it becomes a real de- 
terrent to liberalization, as in California, 
Colorado, North Carolina and Georgia. 

In summary, I say let's above all be 
realistic. I am for abortion on demand 
eventually when the American public and 
the medical profession are prepared for it. 
First, I would like to have effective con- 
traception tremendously well ingrained so 
everyone will have access to it, irrespective 
of marital status or age, because I think 
it is far better from the physical and psy- 
chological points of view to prevent preg- 
nancy than to terminate it. 

Therefore, let us take the time to set 
the stage by having effective contracep- 
tion and the introduction of sex educa- 
tion in the schools. In the meantime, let's 
not live under our current archaic laws; 
let's- liberalize them. And when we get ef- 
fective contraception and greater sexual 
responsibility, then have abortion on de- 
mand as a backup mechanism for failed 
or omitted contraception. 

There seems to be a discrepancy between 



24 



THE MARY SCOTT NEWBOLD SYMPOSIUM 



the issue of contraception and abortion. If 
you espouse the concept of freedom of 
choice for contraception, why is abortion 
different? 

(Dr. Mastroianni) I would like to ask Dr. 
Viel to comment further on this issue of 
contraception versus abortion and on the 
matter of induced abortion in South 
America. 

(Dr. Viel) I can give you the thinking of 
my own country. We have the idea that 
50,000 women are hospitalized because of 
complications due to illegal induced abor- 
tions. Out of them, five per thousand die. 

I would be very glad to have abortion 
on demand. It will reduce the death rate of 
those young women, most of them young 
mothers, and will reduce the number of 
women hospitalized because of complica- 
tions. 

The problem is that we do not have 
enough doctors to perform abortions on 
demand, so if we would succeed in having 
the law of abortion on demand, we will 
have only one more law that, from the 
practical point of view with the number of 
doctors that we have, we would be en- 
tirely unable to keep. 

That's why, like Dr. Guttmacher, I hope 
soon that we will have a contraceptive 
100% effective, in order that abortion on 
demand would not be necessary. 

(Dr. Berelson) I won't speak about the 
medical issues involved, but only about the 
ethical ones. If one holds to the principle 
of freedom with regard to family size and 
the timing of the birth of children, there 
are some people who feel that that freedom 
is already effectively intervened by laws 
proscribing against abortion. In fact, some- 
one has recently described those laws as 
constituting compulsory pregnancy for 
women. 

So if one holds strongly to the principle 
of freedom and does not make a case 
against abortion on grounds of medical 
safety, then it would seem that that ethical 



position ought to include whatever medi- 
cal methods are available, both those of 
foresight and of hindsight. 

Dr. Guttmacher, what was your re- 
sponse to the EROS group in California? 

(Dr. Guttmacher) I told them that I 
thought that, if they spent their efforts on 
increasing the education of the black race, 
they would probably attain political im- 
portance far sooner than by sheer num- 
bers. 

Now, I'm not sure that's valid, but I 
think there is something in that. Perhaps 
I used a bad example, because I used the 
example of the Jew who in numbers is 
about half the number of the Negro and 
still has considerably more political power. 
This is due to his education and also to 
what education brings, financial compe- 
tence. 

What improvements in contraceptive 
technique can doctors anticipate in the 
immediate future? 

(Dr. Mastroianni) A number of groups 
in the United States are working vigor- 
ously on the basic physiology of reproduc- 
tion. The area which has greatest promise 
is not concerned with the events which oc- 
cur at the level of the Fallopian tube. If 
we can understand the fertilization process, 
conceivably we'll be able to control it 
more effectively: if we can understand 
tubal transport mechanisms, with reference 
to both the spermatozoa and the ovum, 
perhaps we will find a means to influence 
those adversely and thus to prevent con- 
ception. 

As has been pointed out, however, one 
of the major issues is not so much method- 
ology, but rather some of the other areas 
which have been so well covered by our 
panelists. Dr. Guttmacher has indicated, 
for example, that the birth rate during 
the Depression in the United States was 
as low as it's ever been. And that was at 



I'OITI.A I I<)\ WW \\( III 



25 



a time wlien we didn't have the Pill and 
we didn't have the IUD. So, it's more than 
a matter of methodology. 

(Dr. Berelson) Of course, I would agree 
that it's more than matter of contraceptive 
technology. Motivation is very important 
in it. I've learned over the years, or I've 
tried to learn, never to talk about motiva- 
tion without saying something about the 
technology involved at the same time be- 
cause these things are so interwoven. A 
difficult technology can be utilized, but it 
takes a very great deal of motivation to do 
it well. But the easier the technology, the 
farther into the curve of motivation one 
can cut, and in the developing world, 
that's of very great importance, and it can 
mean a matter of decades and perhaps 
longer in reaching some "solution" of the 
problem. 

At the Population Council, where we 
put a great deal of energy into scientific 
research for a better technology, we see 
very few realistic possibilities of a new 
major method in the next short period of 
years. We would be very agreeably sur- 
prised if something came along. 

We have been working very hard the 
last few years on what we consider the 
likeliest threshold item, a low progestin 
substance. There is an oral version that is 
only a step toward what we're really after, 
an implant in which the same material is 
put into a silastic capsule which by needle 
can be put under the skin. The capsule is 
so arranged that it leaks the substance out 
at the proper rate over relatively long 
periods of time. We are still in the begin- 
ning of this effort, and if everything goes 
well, and we're lucky, we might see light 
at the other end in about two years. But 
I do not think there is anything of a 
dramatically new character that is closer 
than that. 

Dr. Guttmacher, in the United States 
most of the legislators are men acting on a 



problem peculiar to women. Now, what 
eflort is being made to encourage the male 
to use contraception? 

(Dr. Guttmacher) Very little. You know 
the answer; that's why you asked the ques- 
tion. The point that you want to make is 
that we ought to try to coerce the male or 
persuade the male or seduce the male into 
a sense of greater responsibility in con- 
trolling conception. 

And I agree with you. Vasectomy has 
been very difficult to obtain in most com- 
munities. For the first time in New York, 
the Margaret Sanger Research Bureau is 
starting a vasectomy clinic. They will do 
vasectomies, I think, on Friday morning or 
Friday afternoon — this is no advertise- 
ment — just as one does ordinary medical 
procedures in a clinic. 

This is the first time I know of that 
vasectomy has been publicly being carried 
out like any other standard medical ther- 
apy. We hope that this will proliferate and 
that other family planning clinics through- 
out the country will include male steriliza- 
tion as one of their in-patient services. 

(Dr. Mastroianni) Dr. Viel, you men- 
tioned the concept of "Machismo," and I 
wonder if you would comment on the 
attitude of the South American male to- 
ward a contraceptive technique for which 
he would have some responsibility. 

(Dr. Viel) Vasectomy in Latin America 
is restricted to professional groups. I know 
only professional men who have requested 
it privately to doctors or clinics. In the 
common market, it's very unpopular be- 
cause it is very difficult to point out to a 
semiliterate population the difference be- 
tween vasectomy and castration. 

(Dr. Guttmacher) I'd like to add that 
the -Upjohn Company has a new com- 
pound with which they have shown con- 
siderable success in experimental animals 
that seems to affect the sperm cell within 
four or five days of administration, but I 
think it hasn't progressed beyond this 



26 



THE MARY SCOTT NEWBOLD SYMPOSIUM 



point. People certainly are experimenting, 
looking for a male pill. Obviously, if 
they're just beginning human work, it 
means that it's at least three or four years 
off. So I would say that a male pill may 
be possible, but it doesn't seem as though 
it's coming immediately. It would be a 
great contribution if we could have equal- 
ity in this type of birth control, a female 
pill and a male pill. 

(Dr. Wood) A little while ago I read a 
statement that, if we were able right now 
to do something to keep our population 
at a very steady figure instead of having it 
increase, it would bring very catastrophic 
circumstances, such as having the entire 
population of the country pretty soon as 
old as I am. Has this sort of thing hap- 
pened in Japan and Hungary, where they 
have succeeded in controlling population 
growth? 

(Dr. Berelson) If we in the United States 
were to go to replacement very quickly, 
our age structure would certainly be af- 
fected. As a demographer recently said, it 
wouldn't be very long before the age 
structure of the United States would ap- 
proximate that of St. Petersburg, Florida. 
He further went on to say that he used to 
think thai was a dreadful prospect, but 
with each passing year it had more attrac- 
tion for him. 

I think we have to balance off these 
values. We will have a much older popula- 
tion if we do go to a lower birth rate and 
to replacement. Would that mean a more 
conservative population? Well, by most 
accounts probably it would. In the demo- 
graphic field, as in every other, you don't 
get something for nothing, and one of the 
things you'd have to pay for a stable pop- 
ulation at replacement level, assuming you 
could get to it, would be a shift in the 
age structure with a large proportion of 
the population over 50 years old. Of 
course, these are continuous variables, and 



we could choose some growth, but not as 
much as we have. 

What is your concept of the difference 
between the unborn and the born person? 

(Dr. Guttmacher) That is a very per- 
sonal judgment to make; it comes through 
one's mother's milk, religion and many 
other factors. The Catholic religion feels 
sincerely that it is murder to interfere with 
even the four-celled egg. Interference with 
conception at any point is murder to the 
Catholic. 

I have a different point of view. I don't 
see how anyone can judge which is correct. 
It is a matter of philosophical attitude; it 
is nothing one can prove by either a 
computer or a test tube. My attitude is 
that the early ovum is a collection of un- 
differentiated cells. They then begin to 
differentiate; they then begin to potentiate 
into a human being. But I cannot believe 
that you can equate a foetus which simply 
has a potential for human life and has not 
lived independently of its mother with the 
killing of an individual who has been 
born and has had an independent life, and 
therefore, I do not feel that abortion at 
this stage is murder. 

But I'm quite willing to say that I may 
be wrong and the Catholic point of view 
may be right. But I want them to say 
with equal sincerity that they may be 
wrong and I may be right, because I don't 
think either of us can tell who is right and 
who is wrong. This is a matter incapable 
of proof. It is simply a matter of one's 
ethos and the way one thinks, and, to me, 
people born on the earth have tremendous 
priority to people yet unborn. 

(Dr. Berelson) This is of course a very 
central question, that is, the point at which 
you define life as beginning. If, for ex- 
ample, one is to define life as beginning 
with conception as against pregnancy — if 
by conception one means the fertilization 
of the ovum, and by pregnancy the im- 



POPULATION AVALANCHE 



27 



plantation of that ovum in the only en- 
vironment in which it can live — this be- 
comes an important philosophical or theo- 
logical differentiation in practical terms 
for those who think that the IUD has its 
mode of action in the intervening days. 

What strikes me as very interesting in 
Catholic theology is that Catholic doctrine 
does not take an absolute prohibition 
against the taking of human life — for ex- 
ample, just wars and defense against the 
unjust aggressor. But Catholic doctrine 
does come very close to having an absolute 
prohibition against the taking of unborn 
human life. 

It's interesting to inquire into how that 
should be, because a priori I should have 
though it ought to go the other way. 

Free will is not compromised by being 
subordinated to social need by some form 
of legislation. We see the effect of this in 
Other fields where we demand that some- 
one prove that he's able to drive before we 
issue him a driver" s license, and we at 
least ask people to prove they're healthy 
before we issue them a marriage license. 
Can this not be a governmental require- 
ment that a license be taken out to have a 
child, and that this license is non-re- 
newable except by certain conditions, and 
can this be an effective means of birth con- 
trol? Of course, I cannot say what would 
be the punishments for those who circum- 
vent it, but these problems could be 
worked out. But I wonder if this could be 
a practical means of dealing with the 
problem in the future? 

(Dr. Mastroianni) Dr. Berelson, will you 
comment on the matter of free will and 
on the idea that an individual should get 
some stamp of approval by some govern- 
ment agency indicating his competence to 
be a parent before being allowed to pro- 
create? 

(Dr. Berelson) There are two questions 
involved. One is, could this be done? I 



don't think that one can say that logically 
it could not be done. We do license for 
other things, and logically we could for 
this. I don't think we could politically to- 
day, or what I can see as the foreseeable 
future in this country. However, theie 
would be great administrative problems 
involved if one were to do that, or try to 
do that. 

The second question is whether one 
ought to try to do this in order "to solve 
America's population problem." I would 
be very strongly against this. I don't think 
that the problem today in this country 
calls for a solution so drastic. That violates 
my personal values about this enterprise, 
and I personally think that it's far better 
to try to solve such great human prob- 
lems in which millions of people are in- 
volved through the process of information 
and education. Beyond that, I think that 
if you don't get an informed and educated 
public to understand the reasons for sik It 
a drastic measure, you couldn't operate on 
it anyway. 

So that I am far more inclined to trust 
to informed judgment, informed not 
simply about the consequences for the in- 
dividual family but about the conse- 
quences for the total community, and I'm 
prepared to take my chances with in- 
dividual judgment because the alterna- 
tives seem to me to be far worse. 

(Dr. Guttmacher) I agree with every- 
thing Dr. Berelson said. I would much 
rather have this amount of energy ex- 
pended on trying to eliminate and oblite- 
rate our ghettoes and the underprivileged 
type of American life that 23% of our 
population leads. 

We have seen the birth rate fall auto- 
matically with an increase in education. 
It's always interesting to me that the 
smallest family is achieved by the Negress 
or the black woman who has gone to 
college. I've forgotten the figure. It seems 



28 



THE MARY SCOTT NEWBOLD SYMPOSIUM 



to be she achieves 1.3 children; I believe 
that the smallest American family. 

Well, this simply means that if you can 
raise the standard of living and raise the 
educational horizons of underprivileged 
Americans, we shall see birth rates come 
down extraordinarily, probably not much 
more than replacement levels. 

I would like to make an all-out effort 
on making birth control available, but be- 
fore it's going to be accepted extensively 
by a large segment of the population, we 
must improve their way of living. This is 
where the concentration of effort should 
primarily be made. 

(Dr. Mastroianni) Our time is up. On 
behalf of the panel, I should like to thank 
Dr. Gordon French who was responsible 
for the organization of this facet of the 



activities of The College of Physicians of 
Philadelphia. I should also like to thank 
Dr. Wood, President of The College of 
Physicians. Finally, as chairman, I should 
like to thank the members of the panel 
who have brought to us their collective 
wisdom in such an extraordinary way. 

REFERENCES 

1. Puffer, R.: Las Condiciones de Salud en las 

Americas, 1961-62. Publicaci6n Ciendfica No. 
104, Washington D.C., 1964. 

2. Faundes, A.: Expcriencia en Poblacion San Gre- 

gorio. Primer Seminario Brasilero de Planifica- 
ci6n Familiar. Londrina, Brasil, 1968. 

3. Urlanis, B. Z.: Marxism and Birth Control. Con- 

gress of the International Union for the Scien- 
tic Study of Population. Sydney, Australia, 1967. 

4. Zambra, G. and Cabrera, R.: Experiencia de 

Planificaci6n Familiar en el Area Central de la 
Ciudad de Santiago. To be published. 



Life and Health Insurance Today: A Survey for 
the Practicing Physician* 

Introductions 

FRANCIS C. WOOD, M.U., President, The College of Physicians 

of Philadelphia 

THEODORE H. MENDELL, M.D., President, Philadelphia 
County Medical Society 

Chairman 

VAUGHAN P. SIMMONS, M.D., Vice President and Medical Director, 
The Fidelity Mutual Life Insurance Company 

Participants 

GERALD D. DORMAN, M.D., President-Elect, American 
Medical Association 

PAUL L ROBINSON, M.D., Vice President and Chief Medical Director, 
The Metropolitan Life Insurance Company 

WILLIAM A. SODEMAN, M.D., Scientific Director, The Life 
Insurance Medical Research Fund 

JOSEPH C. WILBERDING, LL.B., Executive Secretary, Medical 
Information Bureau Executive Committee 

D. SERGEANT PEPPER, M.D., Senior Medical Director, Connecticut 
Mutual Life Insurance Company 

ALBERT L. LARSON, M.D., Vice President and Chief Medical 
Director, The Travelers Insurance Company 

R. ROBERT TYSON, M.D., Chairman, Medical Economics Committee, 
Philadelphia County Medical Society 

ROBERT S. PRESSMAN, M.D., President, Pennsylvania 
Society of Internal Medicine 

WALTER A. REITER, JR., M.D., Vice President and Medical Director, 
The Mutual Benefit Life Insurance Company 

ARTHUR E. BROWN, M.D., Vice President and Medical Director, 
New England Mutual Life Insurance Company 

(Dr. Wood) Ladies and gentlemen, we of Physicians, and we hope you will enjoy 

welcome you this morning to The College looking around this fine old building with 

• A symposium presented by the Section on Pub- its museum and paintings. We are glad to 

lie Health, Preventive and Industrial Medicine of 

The College of Physicians of Philadelphia in co- 
operation with Philadelphia County Medical So- Reprint requests may be addressed to Vaughan 
ciety and the Association of Life Insurance Medical P. Simmons, M.D., Vice President and Medical 
Directors of America at The College of Physicians Director, The Fidelity Mutual Life Insurance Com- 
of Philadelphia, 18 January 1969. pany, Philadelphia, Pensylvania 19101. 

29 



30 



A SURVEY FOR THE PRACTICING PHYSICIAN 



see you here. I shall now ask Dr. Simmons 
to proceed. 

(Dr. Simmons) Thank you very much, 
Dr. Wood. It's a real pleasure to be able to 
greet you as Chairman of the Section on 
Public Health, Preventive and Industrial 
Medicine of The College of Physicians. 
This program, as you know, has been 
sponsored by the Section, by Philadelphia 
County Medical Society and by the Asso- 
ciation of Life Insurance Medical Directors 
of America. The Philadelphia County 
Medical Society will be represented offi- 
cially here this morning by its President, 
Dr. Theodore H. Mendell, the 108th Chief 
Executive of this organization. 

(Dr. Mendell) Thank you, Dr. Simmons. 
I want to greet you officially and welcome 
you on behalf of Philadelphia County 
Medical Society and its 4,000 members. 

This hall and this building represent 
part of Philadelphia and United States 
history. While talking about history, I 
might mention that the first life insurance 
company which was incorporated in North 
America was established in Philadelphia in 
the late 1700's. 

Clinical medicine is very much indebted 
to life insurance medicine for its very 
valuable contribution in statistics. The 
practicing physician is a sort of partner to 
insurance because he looks after the physi- 
cal health of the patient, and insurance 
looks after the economic health. You can- 
not separate either of them. 

I am especially pleased to be here, Dr. 
Simmons, and I want to congratulate you 
on arranging this excellent symposium. 
Judging from my meager knowledge of 
life insurance, even after having prac- 
ticed for thirty years and having com- 
pleted hundreds of insurance forms, I am 
going to learn a great deal, and I think 
everybody else will. I want to thank you 
for inviting me. 

(Dr. Smimons) Thank you very much, 
Dr. Mendell. I wish to bring to you also 
the greetings of Dr. Francis Mathewson, 



President of The Association of Life In- 
surance Medical Directors of America and 
Medical Director of the Great-West Life 
Assurance Company of Winnipeg, Mani- 
toba, Canada. Dr. Mathewson regrets his 
inability to be with us this morning, but 
he noted that our program was well repre- 
sented by past presidents of the Associa- 
tion, three of whom will officially be on 
the program this morning and another 
will substitute for one of our scheduled 
speakers who is not able to be with us. 
Three Past Presidents on the program are 
Drs. Robinson, Pepper and Larson. Dr. 
Whitman Reynolds, also a Past President, 
will substitute for Mr. Joseph C. Wilberd- 
ing. 

Our topic for this symposium — "Life 
and Health Insurance Today" — is a timely 
one on the local, national and interna- 
tional scenes. All of us are intimately in- 
volved, be we physicians or laymen. 

A similar meeting, a "Congress on Medi- 
cine and Insurance," sponsored jointly by 
the American Medical Association and the 
Association of Life Insurance Medical Di- 
rectors was held last June in San Francisco 
in conjunction with the annual meeting of 
the American Medical Association. 

It is through such assemblages and dis- 
cussions and via the printed word as the 
aftermath that we hope to foster better 
understanding of the problems we face as 
individuals, as communities and as a na- 
tion and, through this understanding, 
achieve cooperation and meaningful solu- 
tions. 

To this end, we have assembled in this 
room today the finest talent on the subject 
available anywhere in the world. 

Organized medicine, practicing physi- 
cians and doctors of medicine specializing 
in the field of insurance have gathered to 
tell us the nature of their work and the 
problems that we face mutually and to 
create the climate of understanding neces- 
sary to move forward. 



LIFE AND HEALTH INSURANT! IODAV 



31 



The Stake of Private Medicine in Life and Health Insurance 



(Dr. Simmons) Philadelphia medicine 
has been doubly favored this week, first by 
Dr. Dwight Wilbur, President of the 
American Medical Association, who spoke 
at Dr. Mendell's inaugural dinner, and to- 
day by the President-Elect of the Ameri- 
can Medical Association. 

Dr. Gerald D. Dorman was born in 
1903 in Beirut, Lebanon, where his father 
was a Professor and Dean of the School of 
Medicine of the American University. He 
received his bachelor's degree from Har- 
vard in 1925 and his medical degree from 
Columbia University in 1929. Following an 
internship in surgery at St. Luke's Hospital 
in New York City, he engaged in private 
practice as a surgeon from 1932 until he 
entered the Army as a Field Surgeon in 
1912. Having been commissioned as a 
Captain, he rose to Lieutenant Colonel 
while on active duty and, in 1963, retired 
from command of the 307th General Hos- 
pital and the Army Reserve with the rank 
of Colonel. 

From 1945 until June 1968, Dr. Dorman 
served successively as Assistant Medical 
Director, Medical Director, and as 2nd 
Vice President and Medical Consultant 
for the New York Life Insurance Com- 
pany. He has served the American Medi- 
cal Association as Chairman of its Com- 
mittee on Workmen's Compensation, as 
Eastern Co-chairman of its Physicians 
Committee on Radio, Television and 
Motion Pictures, and as a member of its 
Medical Military Affairs, Insurance and 
Prepayment Plans and Health Care Fi- 
nancing committees. 

Dr. Dorman is a Past President of the 
Medical Society of the County of New 
York and has held various high offices in 
his State Medical Society. 

He was a Delegate to the American 
Medical Association from the Medical So- 
ciety of the State of New York for six 
years before his election to the Board of 
Trustees in 1960 and continued in this 



capacity until he was named Presidcnt- 
Elect of the American Medical Association 
in June 1968 by the unanimous vote of the 
American Medical Association House of 
Delegates. 

Dr. Dorman will be installed as the 
American Medical Association's 124th 
President during the annual convention in 
New York in July of this year, and we are 
indeed pleased to have him here to speak 
to us on the subject, "The Stake of Private 
Medicine in Life and Health Insurance." 

(Dr. Dorman) It's always a pleasure for 
me to come back to Philadelphia because, 
although you hear what a foreigner I am, 
having been born in the other end of the 
world in Beirut, Lebanon, my maternal 
grandfather's family whose name I bear 
with the middle "D" in my name — the 
Dales — of Philadelphia, were here before 
the Revolution, through the Revolution 
and for many a year thereafter. So I feel a 
sort of nostalgia in coming back to the 
Philadelphia area. 

When I was invited to be with you on 
this occasion, the subject I was asked to 
discuss was "The Stake of Private Medi- 
cine in Life and Health Insurance." 

It was a pleasure for me to accept the 
invitation on that basis because medicine 
and insurance are subjects with which I 
feel quite comfortable. 

I have been a physician for a good many 
years, which qualifies me to see much of 
medicine's point of view. I also have spent 
a good many years as Medical Director for 
the New York Life Insurance Company, 
which makes it possible for me to see that 
industry's point of view. 

It is not only important, it is virtually a 
necessity that medicine and the broad 
field of insurance and prepayment draw 
closer together in the months and years 
ahead. We have a community of interest 
that demands a close, mutually under- 
standing relationship. 

As a matter of fact, in these days of 



32 



A SURVEY FOR THE PRACTICING PHYSICIAN 



constantly multiplying demands for medi- 
cal and health care, I do not think it 
would be in error to consider members of 
the insurance industry and of the pre- 
payment programs as actual parts of the 
health care team, since it is health insur- 
ance and prepayment that often make it 
possible for the ailing and the injured to 
receive the medical care they need. 

Whatever else might be said about either 
the differences or the relationships be- 
tween medicine and insurance, certainly 
both have ultimate goals that are identi- 
cal. That unified goal is the well-being of 
the people they serve. 

Primarily, the physician is concerned 
with the physical well-being of his patients. 
Primarily, insurance is concerned with the 
economic well-being of policyholders or 
members. But, as all of us know, there are 
many overlapping aspects of these con- 
cerns. 

Insurance also is vitally interested in 
the physical health of its clients, just as 
physicians are equally concerned about the 
economic situation of their patients. 

That latter point is particularly true in 
today's highly inflated economy, in which 
the cost of medical and health care has 
been rising steadily and apparently will 
continue to rise because of a great many 
factors that are outside of the control of 
either the medical profession or the in- 
surance carriers. 

It is, in fact, stated policy of the Ameri- 
can Medical Association that physicians at 
all times should be aware of the economic 
factors of the services they provide and the 
services they order. That consideration is 
in addition to their awareness of the sci- 
entific aspects of those services. 

In keeping with that policy, AMA Presi- 
dent Dwight L. Wilbur, in his report to 
the House of Delegates last month at the 
Clinical Convention, cited eight ways we 
physicians can and must help hold down 
the cost of medical and health care. 

I would like to repeat for you, briefly, 



those eight points, with some elaboration 
of my own here and there. 

First, we can avoid hospitalizing any 
patient unless it is absolutely necessary. 

Second, we can reduce the length of 
stay in the hospital to the absolute mini- | 
mum consistent with good care. 

Third, to help implement the first two, 
we can make more use of extended care 
facilities, nursing homes and home care 
services, as well as participating in the 
expansion of all of those effective and less 
expensive sources of care. 

Fourth, we can stimulate prepayment 
mechanisms on a voluntary basis and en- 
courage all insurance carriers to provide 
comprehensive coverage for out-of-hospital 
services, including those that are required 
both before and after hospitalization. 

A possible option, offered by Dr. Wil- 
bur for consideration, is the recent action 
of National Blue Shield. And you can see 
here that it is almost impossible to talk 
about health care without talking about 
insurance and prepayment. 

National Blue Shield has called for all 
of its member plans to make available a 
"paid-in-full" program of services based on 
physicians' usual, customary and reason- 
able fees. The plan is to include charges 
made in the physician's office, for labora- 
tory and radiological tests, for care in the 
home, for care in extended care and nurs- 
ing home facilities, and for many other 
specified services. 

I think this is an option that should be 
available. 

Fifth, of the eight points, we can en- 
courage our patients and their families to 
carry adequate health insurance or pre- 
payment coverage. 

Sixth, we can support the principle of 
income tax credits for health insurance. I 
shall have more to say about that subject 
later on. 

Seventh, we can encourage wider use of 
reliable, automated laboratory procedures, 
passing the cost benefits on to patients. 



1 111 AM) 111 Mill IVSI K \\( I I ODAV 



Eighth and last of the president's points, 
we can maintain charges for physicians' 
services on the basis of usual, customary 
and reasonable fees, a concept that was 
defined by the House of Delegates last 
month, as you know. 

Accompanying this must be effective 
self-discipline and peer review to consider 
the fee charged and the appropriateness of 
the service rendered. 

If I may elaborate a little on that point, 
1 should like to recall to your attention 
the AMA's "Guidelines for Establishing 
Medical Society Review Committees.'' The 
guidelines were first published in a 1965 
issue of the Journal of the AMA and have 
been updated periodically since that time 
as amendments were made by the House of 
Delegates. The latest of those were re- 
corded from the Annual Convention of 
last year. 

I don't want to take your time to review 
in detail those fairly lengthy guidelines. 
But I would point out, as a reminder, that 
they include provisions: 

. . . for broad representation of all fields 
of practice and medical specialties in the 
community; 

. . . for prompt settlement of cases pre- 
sented to avoid dissatisfaction and loss of 
confidence in the committee's value; 

. . . for adequate publicity so that both 
the profession and the public know of the 
committee's function; 

. . . for continuity of membership in the 
committee to assure consistency in decisions 
rendered in all cases, regardless of the 
source of the complaint or question; 

. . . and finally, the guidelines call for 
consultation with representatives of health 
insurance and prepayment plans in order 
to achieve maximum results. 

Among the ways to help reduce the cost 
of medical and health care to the patient, 
I mentioned the AMA's concept of income 
tax credits to help defray the cost of health 
insurance premiums. 

That idea was accepted by the AMA 



House at its meeting in June of 1968. Last 
month the House not only reaffirmed its 
acceptance, but resolved to promote vigor- 
ously the enactment of federal legislation 
"that would translate into law the concept 
of income tax credits for health insurance 
premiums." 

The report on that subject was from the 
AMA Board of Trustees' Committee on 
Health Care Financing. I have the privi- 
lege of serving that committee as chairman. 

The committee report pointed out that 
adequate health care should be available 
to all who need it and that methods of 
financing health care must be found to 
help everyone get the care he needs. 

Income tax credits for the premiums 
paid for adequate health insurance are an 
effective way to encourage maximum par- 
ticipation in voluntary, comprehensive 
health insurance programs. 

People who don't earn enough to pay 
income tax, or who pay only a small 
amount, would be given vouchers for the 
purchase of health insurance. 

Adequate programs would be available 
from insurance and prepayment carriers 
and people who buy them would be eligi- 
ble for a tax credit for the premium paid. 

For example, if a family owed $500 in- 
come tax, and the premium for adequate 
health insurance was $350, the tax pay- 
ment could be $150 plus the receipt for the 
insurance premium. 

As health care costs continue to rise, 
which we can be certain will happen, we 
who are in medicine and/or insurance 
must more clearly demonstrate the effec- 
tiveness of the private system of medical 
care and of the voluntary health insurance 
mechanism. 

Otherwise, I think we can expect to see 
government moving more deeply into die 
health care field, sometimes using the in- 
creasing cost as a reason and sometimes 
motivated by the lack of availability of 
immediate care. 

I hope that we can expect not only a 



34 



A SURVEY FOR THE PRACTICING PHYSICIAN 



new climate, but a better climate, with a 
new administration and a new congress 
taking over this month. I think we can ex- 
pect to see less of a continuing push for 
greater welfare programs just for the sake 
of welfare. 

However, we cannot expect the present 
government — or any government this 
country might have in the future — to ig- 
nore problems that generate a great deal 
of public outcry. This congress and this 
administration, like any before them, will 
act in what they interpret to be the best 
interests of their constituents and the na- 
tion. 

If they believe gaps exist in the provi- 
sion of medical and health care to all citi- 
zens, or in the ability of vast numbers of 
people to afford the kind and amount of 
care they need, we can expect govern- 
ment action to fill those gaps. We can ex- 
pect it, that is, if the private sectors of 
medicine and insurance are not clearly 
making progress in doing the job. 

With respect to health insurance and 
prepayment coverage, we must work to- 
gether to make them more effective, to 
make their coverage more widespread, to 
make their benefits more comprehensive 
and to make their protection available as 
economically as possible. 

We must believe and, much more im- 
portant, we must prove that government 
financing alone is not the answer to the 
provision of adequate, comprehensive 
health insurance for the people of this 
nation. 

I would like to dispel one cloud that 
has drifted onto the horizon and led some 
people to take a pessimistic view of the 
future of voluntary health insurance and 
prepayment. These people say that the 
cause of voluntary coverage is lost since the 
government has already stepped in with 
Medicare, Medicaid and its many other 
programs. They say the government will 
one day take over completely the financing 



of health care and, consequently, the con- 
trol of it. 

I would like to point out that similar 
predictions of doom were heard from in- 
surance companies back in 1936 and there- 
after when social security was passed and 
went into effect. 

At that time there were cries on all 
sides that there was no further need for 
private life insurance and certainly no 
need for retirement programs, since the 
government was going to provide every- 
thing people would need in their old age. 

What actually happened? The truth 
turned out to be the exact opposite of the 
predictions. Life insurance has never en- 
joyed as much growth as it has in the 
years since 1936. The same is true for the 
growth of retirement insurance, company 
and union pension programs and all 
other private mechanisms for providing 
for one's old age and for the security of 
one's survivors. 

The reason, as we look back, is fairly 
obvious. The establishment of the govern- 
ment's social security program did not 
make available every benefit everyone 
could want. It was a step. 

But more importantly, it called nation- 
wide attention to the need for preparing 
for retirement and putting aside some- 
thing for the golden years. When people 
realized the need for future security, they 
did not try to do away with the govern- 
ment program. But they rushed to take ad- 
vantage of private programs that would of- 
fer them even more. 

1 am optimistic enough and, I think, 
realistic enough to expect the same thing 
to happen to voluntary health insurance 
and prepayment, in spite of, or even be- 
cause of, government health care pro- 
grams. 

Federal interest and Federal action in 
health have called attention to the need 
for good health care and for advance fi- 
nancing of health care as nothing else has 
been able to do. 



LIFE AND HEALTH INSURANCE TODAY 



35 



And I believe we can count on the 
public to want more and better coverage 
for tbeir medical and health expenditures. 

All of us, and all of our colleagues, must 
work together to urge people to protect 
themselves and show them how to do it. 
We must help them understand that it is 
insurance that makes it possible eco- 
nomically to do what needs to be done 
medically. 

We must realize, of course, that in this 
respect we are concerned primarily with 
those people whose economic status is 
above that of the indigent. For the un- 
fortunate who live in poverty, medical 
and health care is available now and al- 
ways has been available. 

Just as those people are unable to pay 
for medical and health care, they also are 
unable to pay for adequate health in- 
surance protection until a system comes 
along such as the AMA's proposed income 
tax credits. 

But they will be cared for, under govern- 
mental or private programs, just as they 
always have been cared for by individual 
physicians. 

The great appeal of insurance and pre- 
payment is to people above that economic 
level who normally are self-sustaining but 
who do not have the resources to cover the 
expense of a major illness or accident. For 
these people, prepayment in any of its 
many voluntary forms can remove the fi- 
nancial deterrent to necessary medical and 
health care. 

That same principle applies all the rest 
of the way up the economic ladder, 
through the whole great middle class and 
even into the wealthy group whose mem- 
bers find it well worth-while to provide 
themselves with adequate insurance cov- 
erage rather than using their considerable 
means to be self-insured. 

Insurance makes it possible for the 
physician to provide or prescribe diagnos- 
tic and therapeutic care of the very best 
type and in whatever quantity is needed 



without putting an undue financial bur- 
den on the patient or his family. 

That will become even more true when, 
at our urging and with our cooperation, the 
insurance industry moves forward to ex- 
tend more protection by allowing payment 
for diagnostic examination or therapeutic 
treatment without confinement in a hos- 
pital, by paying for services in the out- 
patient department, in the physician's office 
or in the patient's home or an extended 
care facility. 

Existing programs of insurance and pre- 
payment too often make patients insist on 
going to the hospital because that is the 
only way they can get any financial reim- 
bursement, even though perfectly good 
care could be provided in some other en- 
vironment. 

I hope, too, that before long the insur- 
ance industry and the prepayment plans 
will expand their coverage to include pre- 
ventive medical care. That is a move which, 
in the long run, I sincerely believe would 
actually save money for the insured in- 
dividual and for the carrier. It would avert 
the need for much more expensive thera- 
peutic treatment after an illness develops 
that could have been overcome quickly if 
it had been caught early enough through 
routine, preventive examination. 

As a final point, in this brief discussion 
of a very far-reaching subject, I would 
like to add that health insurance is by no 
means the only type that helps the physi- 
cian and his patient. 

Retirement insurance and disability in- 
surance both provide a vitally important 
financial lift to many persons. 

That is particularly true of disability 
coverage, which many persons are wise 
enough to purchase while they are healthy 
and working. For people who have not 
taken advantage of such protection, an en- 
forced inability to work — especially for a 
breadwinner — can be a financial diaster 
as well as a physical and emotional prob- 
lem. 



A SURVEY FOR THE PRACTICING PHYSICIAN 



The same is true, although to a lesser 
extent usually, for persons who should re- 
tire for the sake of their health at age 65 
or younger. If his patient is adequately 
covered by insurance, the physician feels 
much more free to advise retirement when 
circumstances warrant it. He knows the 
patient can follow his advice and protect 
his health without becoming a financial 
burden on his family or even on society. 

I think when we look at the field of 
medicine and the field of insurance and 
prepayment, it is clear to all of us that our 
mutual concerns, our existing cooperation 
and our need for further cooperation far 
out-weigh any minor differences there 
might be in our philosophies, outlook or 
personal interests. 

Certainly medicine and the insurance 
industry are partners in both life and 
health. If an obvious illustration of that 

What's Going on in the 

(Dr. Simmons) Our next speaker this 
morning will be Dr. Paul I. Robinson. 
Dr. Robinson was born in Waltonville, 
Illinois, on September 15, 1904. He re- 
ceived his B.S. degree from Washington 
University of St. Louis in 1926 and was 
graduated in medicine from the Washing- 
ton University School of Medicine in 1928. 
This was followed by training at the Army 
Medical School in 1929 and a succession of 
postgraduate courses too numerous to men- 
tion. 

During the course of his military ca- 
reer, Dr. Robinson served as Commander 
of the Fitzsimmons Army Hospital from 
1951 to 1954 and was Surgeon for the 8th 
Army in Korea in 1954 and 1955. He was 
subsequently Commander of the Letterman 
Army Hospital and later Executive Di- 
rector of the Dependents' Medical Care 
Program from 1956 through 1958. He is the 
holder of the Distinguished Service Medal, 
Legion of Merit and Oak Leaf Cluster, 
the Philippine Medal of Merit and the 
Korean Taiguk Medal as well as an Alumni 



partnership is needed, we can find it in the 
more than 20 million dollars contributed 
to medical research through the Life In- 
surance Medical Research Fund. 

And I see no lessening of that partner- 
ship, as long as both of us continue to ful- 
fill our responsibilities, with physicians pro- 
viding and directing health and medical 
care for the people of this nation and 
with the insurance industry helping to 
reimburse patients for the cost of the care 
they receive. 

Working together, all of us can help pre- 
vent physical problems from becoming 
economic tragedies for millions of people 
and for our country as a whole. 

(Dr. Simmons) Thank you very much, Dr. 
Dorman, for this illuminating and authori- 
tative presentation of what is going on and 
for the many suggestions which you have 
offered for our benefit. 

Health Insurance Field? 

Citation from Washington University of 
St Louis. Dr. Robinson retired from the 
United States Army with the rank of Major 
General. 

He is a Fellow of the American College 
of Physicians, the American College of Pre- 
ventive Medicine, the American Public 
Health Association and the New York 
Academy of Medicine. He is an Honorary 
Fellow of the American College of Hospital 
Administrators. In addition, he is a mem- 
ber of the New York State Hospital Review 
and Planning Council and is a consultant 
to the United States Department of Health, 
Education and Welfare on matters relat- 
ing to physician participation in Medicare. 

He has published numerous articles on 
personnel matters, hospital administra- 
tion, health insurance and various aspects 
of the costs of medical care. 

It is a privilege to have Dr. Robinson 
with us this morning to speak on the sub- 
ject, "What's Going on in the Health In- 
surance Field?" 

(Dr. Robinson) It is a great privilege to 



I.I I K AND HEALTH INSURANCE TODAY 



37 



be here to talk on this subject. I shall have 
to tell you that I believe that my talk is 
going to emphasize a number of things 
that Dr. Dorman has already said. 

I'm sure that all of us in the insurance 
industry and all of us in the medical pro- 
fession would like to know what is going 
to happen to health insurance. There are 
movements in several directions which may 
enable us to understand what is going on 
now and possibly to prophesy what the 
future holds in this field. 

Senator Ribicoff is said to be developing 
a program for covering the uninsured seg- 
ments of the population by use of subsidy 
from public funds. 

The American Medical Association's 
Committee on Health Care Financing has 
proposed a program to provide coverage 
for the uninsured and to improve the 
adequacy of insurance coverage for the re- 
mainder of the population. This proposal 
would utilize income tax incentives and 
government subsidies. 

Governor Rockefeller of New York has 
proposed to the Ribicoff Committee a 
program of compulsory health insurance 
with suitable subsidies. He had proposed a 
similar program a year ago. The same basic 
idea is also incorporated in a study en- 
titled, "Problems in Medicaid" by the 
Advisory Commission on Intergovernmen- 
tal Relations. 

The United Auto Workers has proposed 
an all-inclusive compulsory health insur- 
ance program. 

I. S. Falk of Yale University made a pro- 
posal for compulsory health insurance at a 
meeting of the American Public Health 
Association in November 1968. 

Walter P. Reuther, President of the 
United Automobile Workers, announced 
at the 96th meeting of the American 
Public Health Association that a Commit- 
tee for National Health Insurance has 
been formed, chaired by himself, vice- 
chaired by Dr. Michael E. DeBakey and 
having such other members of prominence 



as Mrs. Mary Laskcr and Whitney M. 
Young, Jr. He announced that the Com- 
mittee will launch an educational program 
and "draft legislation to accomplish the 
Committee's purposes and press for enact- 
ment by the Congress." 

The position of the Nixon Administra- 
tion concerning these matters is not now 
known, but we probably must concede that 
the pressures are sufficient to require seri- 
ous consideration of health problems. 

One cannot think in terms of health in- 
surance without considering the increase in 
cost of medicine and hospital service over 
the past several years. Many efforts are 
being made to establish guidelines, if not 
standards, for medical care. Determina- 
tions of necessity for medical service, qual- 
ity of medical service, length of hospital 
stay, reasons for repetitive medical visits, 
efficiency with which medical care is ren- 
dered, both in hospital and out, are repre- 
sentative of these efforts. Fiscal controls 
have been devised and are in use, such as 
physician fee schedules, hospital payment 
formulae, contractual arrangements be- 
tween providers and insurers, prepaid 
group practice plans combining financing 
and rendering of medical care, deductibles, 
coinsurance, internal limitations of one 
type and another, to mention several. 
None has been successful, in the opinion 
of many, because they have shifted the 
burden of additional payments to patients 
or to charitable organizations. Frequently 
the excess cost has been absorbed by in- 
dividual members of the profession. Cur- 
rently the trend is toward payment of 
physicians in accord with their own usual 
and customary charge, if reasonable. Rea- 
sonable determinations are made in an 
ill-defined manner by payers, some using 
average fees in a locality, others compari- 
son of fees with previous ones submitted 
by the same physician, and still others 
using the latter method, provided the fee 
falls within 90 percent of the average of 
all physicians' fees in the locality. The 



38 



A SURVEY FOR THE PRACTICING PHYSICIAN 



physician's usual fee is determined by 
questionnaire survey or by actual study of 
fees submitted and on record in the payer's 
files. 

The demand for medical care has been 
influenced by many factors. Good food, 
cleanliness and reduction in work stresses 
have gone hand in hand with vaccines, 
antibiotics, antihistamines, better anesthet- 
ics and improved surgical techniques in 
both increasing and decreasing the quan- 
tity of medical care desired by the people. 
While infectious and contagious diseases 
have reached a reasonable state of control, 
chronic degenerative conditions have come 
more and more to the forefront and now 
require a greater quantity of medical and 
technical skills than ever before, both in 
detection and treatment. 

The goal of good health for all mem- 
bers of society is unquestionably in the 
public interest and can be supported by 
providers of health care, industry, labor, 
insurers and government. This statement is 
greatly oversimplified because of the enor- 
mous complexities inherent in getting all 
to work together in an organized program 
which will preserve free enterprise and yet 
provide quality health service for all the 
people. The situation is a mixture of per- 
sonal and group attitudes toward life it- 
self. The complexities not only involve 
procedures, practices and behaviors grow- 
ing out of expanding knowledge of disease, 
mental illness and disability, but also 
economic and social problems relating to 
organizing and educating people to pro- 
duce goods and services under a system of 
adequate compensation for their contribu- 
tions. In order for all elements of our 
society to work together toward a common 
goal of good health for everybody, more 
understanding of all the problems must be 
available to all. 

Transferring all the responsibility for 
the health of all the people to the Federal 
government does not seem to be a viable 
solution. The Federal government has for 



many years operated large medical care 
programs which from time to time have 
been found to be wanting, and changes 
have been accomplished by the free enter- 
prise medical profession. On the other 
hand, government has developed a medical 
care organization consisting of prompt, 
always-available medical care, rapid trans- 
port to the type of medical facility re- 
quired and specialty care of unquestioned 
stature, some counterpart of which is badly 
needed in our free enterprise system. 

Those opposing the government's entry 
into the medical care field have been un- 
yielding in a number of general policies, 
such as: 1., opposition to compulsion; 2., 
government subsidies; 3., use of general 
revenues and 4., extension of present gov- 
ernmental programs, such as Medicare and 
disability coverage. Yet no one opposes the 
premise that everyone is entitled to neces- 
sary health care regardless of the means of 
payment therefor. 

While everyone must concede and recog- 
nize the tremendous developments which 
have been made in the last 25 years in 
private insurance as well as government 
programs of health care, it cannot be 
denied that gaps and inequities still exist. 
Because of the goal of good health for 
everyone (which is undisputed), there is no 
doubt that there will be in the next few 
years many meetings, congresses, commit- 
tees and conventions in which solutions 
will be expounded. Many of the long- 
existent policies on all sides must be com- 
promised or attenuated. 

It would be impertinent of me to pre- 
dict what will come about or how it might 
be accomplished, but certainly all the 
activities I have briefly reviewed would 
point to: I., more complete benefits for 
those covered by health insurance and 2., 
extending the same benefits to the unin- 
sured by some means which undoubtedly — 
in the early stages at least — must be under 
government subsidy. 

The extension of benefits must be con- 



LIFE AND HEALTH INSURANCE TODAY 



39 



Structive. Those controls which have been 
shown to increase costs by forcing people 
Into the hospital for diagnostic examina- 
tions and trivial care must be eliminated 
or modified. Many of the built-in limita- 
tions should be excluded. More health 
services — dental, drugs, psychiatric, reha- 
bilitation and preventive services — are 
desired. It is my sincere belief that the 
people want such a system and that they 
will somehow find the means to pay for it. 
It is my hope and belief that people who 
work can be provided with almost com- 
plete health insurance coverage in the free 
enterprise system. It will recpiire com- 
promises and concessions as well as as- 
surances on the part of providers of health 
care and health insurers to accomplish 
this. There will always be an uninsured 
group. Those who have permanent un- 
correctable impairments probably will 



have to be cared for by government; others 
who have capabilities should be provided 
witli rehabilitative training and medical 
care until they can be converted into pro- 
ductive individuals. 

In a word, it would seem that health in- 
surance will in time cover more and more 
of the population and will provide greater 
and greater benefits, that there will be a 
great struggle during the next few years to 
delineate what can remain in the free en- 
terprise system and what must be provided 
by government, that the providers of 
health care and the financiers will revise 
some of their staid policies and practices to 
meet the needs of the times, that there will 
be developed an organization for more 
efficient delivery of medical care, and that 
government will more clearly outline and 
define its obligations so that the free enter- 
prise segment can proceed to develop in 
the health insurance field. 



The Life Insurance Medical Research Fund 



(Dr. Simmons) Our next speaker this 
morning is Dr. William A. Sodeman, a 
native of Pennsylvania, who received his 
basic education in the public schools of 
Toledo, Ohio. He holds both the Bachelor 
of Science and the Doctor of Medicine 
degrees from the University of Michigan, 
the latter having been received in 1931. In 
addition, he holds the honorary degrees of 
Sc.D. from Villanova University and 
L.H.D. from Jefferson Medical College. 

He has an illustrious background from 
which I can select only a few major items. 
From 1941 through 1946, he was Professor 
and Head of the Department of Preven- 
tive Medicine at Tulane University School 
of Medicine. He was then named Professor 
of Tropical Medicine and Chairman of the 
Department of Tropical Medicine and 
Public Health, a position which he held 
from 1946 to 1953. From 1953 to 1957, he 
was Professor and Chairman of the Depart- 
ment of Internal Medicine at the Uni- 
versity of Missouri School of Medicine. In 



1957, he came to Philadelphia to become 
Magee Professor of Medicine and Head of 
the Department of Medicine at Jefferson 
Medical College. He became Dean and 
Professor of Medicine in April 1958 and, in 
February 1962, Vice President for Medi- 
cal Affairs. He remained in this post until 
June 30, 1967, at which time he became 
Scientific Director of the Life Insurance 
Medical Research Fund at Rosemont, 
Pennsylvania. He is a member of numer- 
ous boards of trustees and is author of the 
monograph, "Pathologic Physiology," 
which has been translated into the Portu- 
guese, Italian, Spanish, Serbo-Croat, and 
Japanese languages. He has contributed 
192 articles to medical literature. 

In addition to being a member of the 
Philadelphia County Medical Society and 
The College of Physicians, he reports 
annually to the Association of Life Insur- 
ance Medical Directors. Thus, he repre- 
sents ail three sponsors of this morning's 
symposium. 



40 



A SURVEY FOR THE PRACTICING PHYSICIAN 



It is a pleasure for me to introduce Dr. 
William A. Sodeman who will address us 
on "The Life Insurance Medical Research 
Fund." 

(Dr. Sodeman) It isn't often that one 
participates in a discussion sponsored by 
three groups and at the same time is a 
member of all three. I appreciate it very 
much. I came to Philadelphia 12 years ago 
and joined The College of Physicians at 
that time. From that time until now, when 
I enter this building, with its atmosphere 
of dignity and stateliness, I get the kind of 
feeling one experiences when he enters one 
of the old cathedrals of Europe. And then 
when one enters this Hall and sees in the 
portraits on the walls such people looking 
down at him as Weir Mitchell, Benjamin 
Rush, William Osier, Dunglison and 
Gross, one really develops this feeling of 
awe and respect. I think it's easy to un- 
derstand why an organization such as the 
Life Insurance Medical Research Fund 
had its beginnings, and had its prime 
champion for its beginnings, in a city 
with the kind of medical background 
possessed by Philadelphia. Although many 
people participated in the development of 
the Life Insurance Medical Research 
Fund, it was Albert Linton, President and 
then Chairman of the Board of the Provi- 
dent Mutual Life Insurance Company here 
in Philadelphia, who was the moving force 
in the discussions to create this Fund in 
1940 and in its final establishment in 1945. 

We've heard this morning that the first 
insurance group in this country was estab- 
lished in Philadelphia and again I can 
say that this Research Fund, for this in- 
dustry, was established here as well. At the 
time, there were about 500 life insurance 
companies in the United States. There are 
now about 1,700. At the time, there was 
little in the way of governmental activity 
in research. The Federal budget for re- 
search in medicine was only several million 
dollars. The establishment of the Fund, by 
an industry, to look into the problem of 



health and particularly into those diseases 
shortening life was a very important and 
very fundamental approach. And it has 
continued to be so. Since that time, of 
course, the government has evolved an or- 
ganized approach to research to such a 
great extent that it has overwhelmed all 
other funding in this country. Since 1945, 
the Life Insurance Medical Research Fund 
has put $25 million into research. The 
Federal government has put, as you know, 
well over S500 million yearly into compar- 
able activity. Many of the NIH programs, 
which run up close to a billion dollars, are 
not all basically for project research. 

One would think, then, that a fund 
such as our own, which was established for 
and does support research projects related 
to biomedical problems, might add very 
little at present to what goes on in research 
in this country with its dollars but a drop 
in the whole pot of money that exists. But 
this isn't true, and it isn't true for several 
reasons. In the first place, we have within 
the insurance industry some very dedicated 
people who help keep the Fund in perspec- 
tive. This is true of the medical directors 
who participate in Fund activities. Here 
today, we have Dr. Paul Robinson, who 
just talked to us and is just retiring as one 
of the Medical Directors' representatives 
to the Fund. Dr. Sergeant Pepper, who is 
here, is in the same group. Dr. Thomas 
Sexton and Dr. Albert Larson, both of 
whom are here this morning, are others. 
These men supply an input into the Fund 
from the medical components of the in- 
dustry not only for review but for comment 
on and help in the maintenance of the 
Fund in its proper perspective. This is very 
helpful. Then, too, if our funds are to be 
utilized effectively, since we have only 
about a million and a half a year, we must 
be selective in the projects chosen. We 
must use this money strategically to help 
people in research so that we are not 
merely adding our component of money to 
the same programming coming out of 



LIFE AND HEALTH INSURANCE TODAY 



41 



Bethesda. By strategically picking pro- 
jects in the utilization of this money, we 
have accomplished this purpose. One of 
the examples is the fact that the Fund, as 
small as it is, has supported five individuals 
who have become Nobel Prize winners. 
Anybody can support a Nobel prize win- 
ner after he gets the prize, but, when a 
group in its selection of people does this 
five to ten years before that time, you can 
see their evaluations are done effectively. 
This work is done through a mechanism 
which is very very efficient, through an 
Advisory Council which meets once a year 
to select for support those requests consid- 
ered promising out of the programs sub- 
mitted. From its very beginning this 
Council has been manned by those highly 
respected in medical education and re- 
search activities in the academic commu- 
nity. At the present time we have on this 
Council such individuals as James Wyn- 
gaarden whom many of you in Philadel- 
phia know from his activities at the 
University of Pennsylvania as well as at 
Duke. Until recently, Carl Moore, Pro- 
fessor of Medicine and Head of the Depart- 
ment of Medicine at Washington Univer- 
sity was our Chairman. That position now 
falls to C. R. Park, who is Professor of 
Physiology at Vanderbilt. The Council in- 
cludes David Bates of McGill, Frank Dixon 
who is a research pathologist at La Jolla, 
Robert Forster, Professor of Physiology at 
the University of Pennsylvania, Donald 
King, who is Professor of Pathology at the 
College of Physicians and Surgeons at 
Columbia, Donald Seldin, Professor of 
Medicine at Texas Southwestern, Richard 
Egdahl, Professor of Surgery at Bos- 
ton University, Albert Lehninger, Hans 
Neurath and Emil Smith, Professors of 
Biochemistry at Johns Hopkins, Washing- 
ton University and UCLA respectively. It's 
this kind and this level of academic com- 
petence which has brought about the 
utilization of these funds very effectively. 
The Fund has two other programs aside 



from support of projects in research. We 
have an activity which we call a Medical 
Scientist Program. In this activity individ- 
ual students in schools of medicine in this 
country and Canada, chosen by their medi- 
cal schools, may be put up for selection by 
our esteemed Advisory Council to enter 
into a program leading to both the M.D. 
and the Ph.D. degree. These programs 
stimulated by the Fund now are beginning 
to evolve in many medical schools. There 
have been some pilot programs supported 
by the National Institutes of Health, but 
this program has not evolved very effec- 
tively as yet. We have at the present time 
131 individuals in this activity in various 
medical schools in this country and 
Canada. Anybody can support a student in 
medical school and it's fine if they do so, 
but those of us who have worked in medi- 
cal schools (and I was in the dean's office 
for 10 years, which is twice as long as the 
average) know that anyone who enters 
medical school today can find, through 
federal and private sources, the support he 
needs, even if he doesn't have much in the 
way of personal financial backing. Conse- 
quently, one ought to do something more 
than this if he has limited funds. And we 
have done so, selecting those having po- 
tential in research and medical education 
to develop in them a background in in- 
vestigative methods as they evolve in both 
the M.D. and the Ph.D. programs to be- 
come educators and to become basic in- 
vestigators in biomedical research. You 
might say we are drawing people from 
practice when we do this, but let me point 
out to you two things: first, this is a small 
group and those going into research in 
medicine represent only 5 to 8% of those 
in medical schools at the present time. Our 
program isn't increasing this component; 
it is making some of these individuals 
sounder individuals when they go into 
their chosen activities. Second, in the 
manpower problems we have today and 
the need to expand the medical schools, we 



42 



A SURVEY FOR THE PRACTICING PHYSICIAN 



need people of this type. Therefore, this 
program which was started by the Fund 
represents one of the important tech- 
niques the Fund has of implementing pro- 
grams in fundamental areas which nobody 
else is considering. This has been a very 
effective approach and one can see in most 
of the medical schools across the country 
that this idea is catching on with money 
obtained from other sources to carry 
through with it. Of the 131 individuals we 
have chosen, some of them have left our 
program at a time when they could get 
funds from other sources. But their goals 
have remained established. Out of the 131, 
we have had only five individuals not 
measuring up to their goals, that is, who 
have decided not to do biomedical research 
and not to teach. They wanted to go into 
practice. In only five of the 131 has this 
happened, and I think this is a good 
record. 

The Fund has one more program, our 
so-called third program, which is just 
evolving at the present time. This activity 
has to do with some of our country's major 
problems. We've heard about the man- 
power shortage this morning. I am very 
concerned about it and serve on Dwight 
Wilbur's Council on Health Manpower 
at the AMA. All of us who are interested 
in this problem know that it isn't a num- 
bers game only, that we have our problems 
not only of having more individual physi- 
cians to lead health teams and having more 
allied health personnel but, in addition, 
we have deficiencies in techniques for 
delivery of health care. This problem has 
been established by any number of groups: 
by the AMA in its approach, by the 
President's Commission on Health Man- 
power and by many others. We have num- 
bers of our citizens who never gain entry 
into our health care systems satisfactorily. 
And we need methods to correct this. 
These problems have not been taught ef- 
fectively and have not been approached 
effectively in the medical schools. They 



require individuals who have background 
in areas other than the basic medical 
sciences. Preparation is not for bench re- 
search, not for the kind of research the 
biochemist does. Consequently, their back- 
ground in basic science must be of another 
kind. It must be in economics, in political 
economy, in chronic epidemiology, and in 
a number of related areas. We have very 
few people trained in medical sciences and 
in these fields as well. Those who manage 
the Fund, that is, the members of the 
Board of Directors who represent the in- 
surance industry, felt that this area re- 
quired an effective program, in which we 
could choose and train individuals who 
have status on their own medical school 
faculties, who have the desire to do this 
kind of work, who have already reached 
status in one of the divisions of medicine 
(whether this be internal medicine, pedi- 
atrics, surgery or whatever it is) and who 
plan to enter into a research program of 
this sort. There are now many departments 
of community medicine in medical schools, 
but many of these are set aside from the 
rest of clinical medicine. Because penetra- 
tion into the community in this kind of 
program is extremely important, partici- 
pants must relate with status to the clinical 
departments. If we take individuals of the 
sort who have this interest and we fund 
them in partnership with the school so that 
they will evolve in that school to teach 
students and do research in these areas, 
they will have an influence on other mem- 
bers of the faculty, influence upon the 
students and an impact on delivery of 
health care within the medical center as 
well as outside the medical center. We will 
have developed in this way a focus in 
strategic places in this country for the de- 
velopment of this research. As you can see, 
we put our money again in men; we put 
our money where we get the most out of 
the small amount of money we have; we 
develop men who have an influence for a 
generation. In turn, these individuals can 



LIFE AND HEALTH INSURANCE TODAY 



43 



obtain project research money from other 
sources. But you must have those who 
know what to do to ask for such project 
money. This is the basis for the third pro- 
gram of the Life Insurance Medical Re- 
search Fund. It is just starting. We have 
made only one grant thus far and that was 
a month ago. It was made to the University 
of Rochester School of Medicine in the 
Department of Medicine to Dr. Paul 
Griner, an Associate Professor of Medicine 
there. We plan to set up several more 
projects this year. We think the program 
is very fundamental. 

You can see that the Life Insurance 
Medical Research Fund, although it has 
restricted money, utilizes those funds in a 
very effective and efficient way so that it 
strategically can get the most mileage out 
of its dollars not only for the Fund and for 
the industry, but for the good of the 
health of the country. We need more 
money as everybody in research needs 
more money, and we do have plans for 
greater participation of the industry. 
Those of you who have read the report of 



the President's Commission on Health 
Manpower saw several significant state- 
ments there. One is that this total prob- 
lem, with all the tax money that the Federal 
government has, is too big for the Federal 
government alone. This means that private 
sources in all areas, whether from founda- 
tions that are independent completely, 
whether from areas supported by various 
groups and various industries, or whether 
from various other segments of society, 
have a very important part in inter-re- 
lating to supplement and complement the 
total funding in health research in this 
country in the most efficient way that it 
can be done. We think that the Life Insur- 
ance Medical Research Fund and the life 
insurance industry, through the Fund, is 
accomplishing this. 

(Dr. Simmons) Thank you, Dr. Sode- 
man. The Life Insurance Medical Re- 
search Fund has done fine work over the 
years and is continuing to do so under 
your leadership and we are very fortunate 
to have a person of your caliber to provide 
this impetus to the work. 



The Medical Information Bureau 



(Dr. Simmons) The next presentation 
was prepared by Mr. Joseph C. Wilberding 
who received an A.B. degree from Yale 
University in 1934 and an LL.B. degree 
from Columbia in 1937. He was associated 
with the New York law firm of Bleakley, 
Piatt and Walker from 1937 to 1939. 
Following this, he joined the Legal Depart- 
ment of the New York Life Insurance 
Company where he remained until 1947 
except for service in the United States 
Army. In 1947, Mr. Wilberding became 
Executive Secretary of the Medical Infor- 
mation Bureau and has continued in this 
position since that time. He has served 
with distinction in this post and has be- 
come well-known and well-loved by the 
medical directors and lay underwriters 
with whom he has w r orked over this long 
period of years. 



Unfortunately, Mr. Wilberding has been 
stricken with the flu and is unable to be 
with us. However, we do have a copy of his 
paper and, in view of the importance of 
this subject, it will be read by Dr. Whit- 
man M. Reynolds, 2nd Vice President and 
Medical Director, Bureau of Insurance 
Medicine of the Equitable Life Assurance 
Society of the United States. 

(Read by Dr. Reynolds) It is my part of 
this program to talk to you regarding the 
organized exchange of medical information 
between the medical directors of life insur- 
ance companies. The organization respon- 
sible for this activity is called the Medical 
Information Bureau and I am its Execu- 
tive Secretary. 

I feel sure that most of you, over the 
years, have realized that some sort of in- 
stitutionalized exchange of information 



44 



A SURVEY FOR THE PRACTICING PHYSICIAN 



occurred between life insurance compan- 
ies. However, since we have seldom gone 
out in the world to publicize or explain 
our work, I am afraid there is a fair 
amount of misunderstanding about our 
activities. 

In recent years we have tried to dispel at 
least some of this misunderstanding by 
talking about the Medical Information 
Bureau openly and frankly in the insur- 
ance business. However, this meeting today 
is the first time that I have talked gen- 
erally about the Bureau outside the con- 
fines of the insurance world. 

Now I don't expect to dispel any in- 
grained prejudices, in this brief talk, but I 
do hope that as a result of what I have to 
say, most of you will feel that the Medical 
Information Bureau is a reasonable system, 
that it was founded to meet an obvious 
need, and that it has been organized so as 
to protect the reasonable interests of all, 
including those persons who apply for life 
insurance, honestly and in good faith — in 
other words, many of those "forgotten 
people" mentioned in our last election. 

My approach will be along these lines: 

First, I should like to describe what I 
see as the nature of the underwriting proc- 
ess in the case of ordinary life insurance. 
This, I believe, will indicate the reasonable 
need for an information exchange. 

Second, I shall describe the nature of the 
exchange, what information goes into it, 
how it is handled, and what limitations are 
put on its use. 

And, finally, I would talk very briefly of 
the future, and a possible contribution 
that this exchange may make to medical 
research, going beyond its present life 
underwriting function. 

Now as to the nature of the life insur- 
ance underwriting function. Here, I think 
there are three points. These are simpli- 
fied, and underwriting is, of course, a 
complicated subject about which far more 
can be said. These points are, however, 
basic and they do relate to our Bureau. 



First, please don't think of life insurance 
as simply a series of business corporations, 
merchandising, through persistent agents, 
a product whose sale sometimes results in 
profits and sometimes in losses — but where, 
in either event, the results, good and bad, 
are picked up by stockholders. This is 
simply not the case. 

Fundamentally, life insurance is a group, 
or groups, of people who have gotten to- 
gether to share the cost of a predictable 
hazard — death. Perhaps better stated, they 
are groups of people who have been as- 
sembled through the efforts of life insur- 
ance agents to share together the cost of 
the hazard. The agent is the catalyst who 
brings people together in their own inter- 
est, rather than the driver who forces 
people to buy a product. 

Now many of the people, who join to- 
gether in these groups, go a bit further and 
use life insurance as a means of cash 
saving, as well as a sharing of the cost of 
the hazard. The benefit of mass saving is, 
of course, another reason for the purchase 
of life insurance, but it is not the funda- 
mental basis of the arrangement. You 
can save on a mass basis at a savings bank 
or a mutual fund, but only if life insurance 
is involved can you cover the risk of death. 

It is from these groups of people, in 
their sharing of the risk, that most of the 
funds come to pay off the contracts. It is 
true there is investment income (and there 
is also agency and company expense), but 
by far the greater portion of the money 
involved is contributed by the policyhold- 
ers as premiums, and most of it goes to pay 
the beneficiaries. This is where the money 
comes from; this is where most of it goes. 
Inasmuch as most of us own life insurance, 
life insurance is "us," not "they." 

A second underwriting point is absolute: 
every applicant for life insurance will die, 
but it is impossible to say exactly when 
for any individual. It is, however, possible 
to foretell to a remarkable degree, through 
statistics, that a certain number of any age 



LIFE AND HEALTH INSURANCE TODAY 



45 



group will probably die, from some cause 
or another, within any one year. There- 
fore, sooner or later, in the absence of lapse 
in payment of premiums, he or his heirs 
will be collecting his share of the group 
kitty. 

The basic question to be decided when 
the individual applies for life insurance is 
how much he should pay into his group 
each year, in order to contribute his fair 
share to the predictable death benefit pay- 
ments that will fall due each year. If he 
doesn't contribute his fair share, some 
other policyholder, somewhere, will make 
it up. 

Now remember, he has designated what 
he wants as his share at the time he enters 
the group. In other words, when he ap- 
plied for life insurance, he designated the 
face amount of the policy. These face 
amounts can run from five hundred dollars 
to over sixteen million dollars on one life, 
and they may provide for payment of 
premiums — or contributions to the kitty — 
over extended periods of time, one to 
fifty or more years. There may be a lot at 
risk in the case of one individual. 

This is where the medical underwriter 
comes in. He must make the decision as to 
I what group the applicant belongs in and, 
in effect, how much premium he should 
pay in order to make his fair contribution 
to the group. And if the premiums have 
| not been properly calculated, or if too 
I many poor longevity risks have been ad- 
mitted to the group, and numerous early 
I losses have occurred, then it is likely to be 
I the remaining policyholders who will, di- 
rectly or indirectly, make up the funds to 
pay these losses. 

The underwriter has certain tools to 
help him. For instance, he has a standard 
mortality table showing the probable 
longevity of groups of individuals, based 
1 on age. This is the basic life insurance 
tool, and with it the underwriter can figure 
out the necessary premiums, using age 
alone, if he can assume that the amounts 



at risk will be uniform, at a relatively 
small level, and that all his applicants are 
in an average state of health. Rut not 
everyone who applies is in good health, or 
even an average state of health, and, as 
previously indicated, the applications can 
be in varying amounts, even up to the 
previously-mentioned sixteen million dol- 
lars. So the underwriter must go further 
than just determining age before admitting 
an applicant to the group; he has no alter- 
native but to try to find out the state of 
health of the applicant. And remember, 
the applicant has opened the door to such 
an inquiry by applying for life insurance. 

There are two situations when this need 
is apparent: 

1. Where the applicant is in truly bad 
health and has minimal prospects of 
even the shortest longevity. Here, for 
this individual to make an adequate 
contribution to cover his fair share of 
the risk, such a large payment would 
probably be required that the policy 
would be unattractive to him. Prob- 
ably also there would be very few per- 
sons similarly situated who would 
wish to purchase life insurance at 
such a cost, and thus you would not 
be able to form a group, and remem- 
ber, group sharing of the risk is the 
basic principle of our business. These 
people are, therefore, usually consid- 
ered uninsurable. It is interesting to 
note that the life insurance business 
has whittled away at the number of 
situations that it considers uninsur- 
able, so that now only approximately 
2 to 3 percent of ordinary life appli- 
cations are not accepted. Higher mor- 
tality groups are being assembled and 
risks are being taken in so-called "ex- 
perimental" cases. From the experi- 
ence with these cases, it is hoped that 
further mortality groups can be de- 
veloped on a basis that will be attrac- 
tive to many risks usually considered 
uninsurable. 



46 



A SURVEY FOR THE PRACTICING PHYSICIAN 



2. Where there is some health history 
that indicates the individual does not 
belong in a standard mortality group. 
Over the years, the life insurance 
business has made statistical studies of 
many aspects of health history. I feel 
sure most of you are familiar with the 
build and blood pressure studies. It 
has been clearly shown that the mor- 
tality rate for some such groups ex- 
ceeds the standard rates. However, it 
is also possible to insure these people 
for life insurance by calculating what 
this extra risk is and requiring higher 
premiums. In such an event, if 
enough of them are insured, they will 
make an adequate contribution to the 
kitty so as to be able to be acc epted for 
large amounts. This is usually referred 
to as substandard or extra risk issue, 
and, although only 6 percent of the 
number of policies issued in a repre- 
sentative year (1967) were substandard, 
the volume at risk was quite large. For 
instance, in 1967, over six billion 
dollars of extra risk ordinary life in- 
surance was issued, and the total 
amount of such insurance in force at 
the end of the year was over thirty 
billion dollars. 
The presence of an adverse health his- 
tory is thus a vital factor in the under- 
writing of about 9 percent of the applica- 
tions. 

But the ability to obtain adverse health 
histories is not only of assistance to these 
cases; it is also an assurance to the under- 
writing of the remaining 91 percent of the 
cases which are accepted standard. 

In situations where there is an extra, 
but acceptable, risk, the underwriter must 
see that such individuals are placed in 
groups that pay an extra premium for the 
extra hazard. I would emphasize that the 
medical underwriter does not make a medi- 
cal diagnosis; he simply tries to group in- 
dividuals with like individuals in the same 
statistical group, so that all will make their 



fair contribution to the pool. There is a 
difference in the two decisions, and it is 
one that is sometimes misunderstood by 
the public. This point will be mentioned 
by others here today. 

The underwriter has a lot of choices of 
various boxes (or groups), in which he 
may put the various extra-risk applicants, 
and he may have a lot, or only a little, 
medical information. There is no doubt, 
however, that the more and the better 
medical information he has, the better 
and fairer decision he can make. 

Naturally, companies in our business 
take different attitudes towards different 
impairments. Although, as previously 
stated, statistical studies of impariments 
are available, they are usually of past his- 
tories, and their use must be tempered by 
knowledge of the advances of medicine. 

The action of the companies will differ 
on many occasions as a routine matter. 
The point is that they must be able to 
make informed judgments in order, basi- 
cally, to see that each policyholder makes 
a fair contribution to his group. And to 
make an informed judgment, the medical 
underwriter must have the maximum 
amount of medical information reasonably 
available to him. 

Now, there is a third point relating to 
underwriting which is more sociology than 
medicine or insurance. I would mention 
that among applicants for life insurance 
there are the forgetful: they don't remem- 
ber that hospital visit three weeks ago. 
There are the dupes: they let the broker 
fill out the application. And there are the 
outright cheats: people who are willing, 
ready and anxious to have someone else 
accept their burdens. 

Fortunately, there are really not too 
many of these bad eggs in the world, and, 
despite what you may hear and feel, I am 
informed by many underwriters that the 
situation in regard to this type of dis- 
honesty is not discernibly worse than it 
was thirty years ago. Still and all, it is 



LIFE AND HEALTH INSURANCE TODAY 



47 



obvious that for any business that is ac- 
cepting large risks with other people's 
money, some steps must be taken to guard 
against the deprivations of the dishonest. 

Experience indicates that where an in- 
dividual has applietl to one company and 
has been declined or rated, he is more 
than anxious to secure some life insurance; 
and at this point, when he comes to an- 
other company, knowledge of prior find- 
ings may be especially valuable where 
there is an effort to defraud. 

It therefore seems obvious that the medi- 
cal underwriter must have available to him 
medical histories and histories acquired by 
other insurance companies in connection 
with applications for insurance should be 
especially valuable. This is the reason for 
the existence of the Medical Information 
Bureau. Insofar as the industry has ac- 
quired any previous knowledge about an 
individual, on his subsequent application 
; for further insurance the new medical 
underwriter will have at least some signal 
as to what has been previously found. 

Now what is the nature of this exchange? 
The Medical Information Bureau is an 
unincorporated, non-profit trade associa- 
tion. It now has over seven hundred 
members, in both the United States and 
Canada. Each of these is a life insurance 
company and each must be so qualified 
within the definition of the United 
States Internal Revenue Laws. Each mem- 
! ber has a locally-licensed physician serving 
as Medical Director. Both the member 
company and the Medical Director, as an 
individual, must sign a pledge that the 
rules and principles of the organization 
will be followed. 

The Bureau was founded in 1890 by 
the Association of Life Insurance Medical 
Directors and until 1947 was operated as 
a function of that organization. In 1947 
the Bureau was reorganized as a separate 
institution to be governed by an Executive 
Committee of nine company officers. Four 
of the members are medical directors, four 



are company senior officers other than 
physicians, and one is a general counsel. 
This committee is responsible for the 
management of the Bureau. 

Reporting Procedures 

Naturally, lines must be drawn as to 
what information is required to be for- 
warded to the Bureau by the members. 
The Executive Committee has done this 
by adopting a so-called List of Impair- 
ments. This list covers a broad spectrum 
of health conditions and other factors 
that could be of some significance to the 
home office underwriters. 

If a member company, in considering 
an application, or even preliminary in- 
quiry, finds one of these conditions, then 
that company is pledged to report such 
information in brief, three-digit, form to 
the Bureau's central office. These entries 
are made daily by member companies, and 
each separate condition is indicated by a 
code number. The Bureau handles up to 
nine thousand such entries a day. 

The new entries are correlated with in- 
formation already on file and made avail- 
able thereafter to any member company 
who has received an application or in- 
quiry or claim from the individual. The 
members check the names of all ordinary 
life cases with the Bureau records and 
information may be found, depending on 
the company, in 5 to 40 percent of the 
cases submitted. Periodic studies by mem- 
bers indicate that substantial mortality 
savings result from checking cases through 
the Bureau. 

Sources of Coded Information 

The Bureau receives these entries of 
coded information only from its members. 
There are no outside sources of informa- 
tion. The Bureau has no employees who 
go out to investigate or examine individ- 
uals. All information is provided by the 
members. 

The members do not indicate whether 



48 



A SURVEY FOR THE PRACTICING PHYSICIAN 



an application has been declined or rated 
or postponed or accepted. They also do not 
state the amount of insurance applied for. 
In sum, the underwriting evaluation of a 
case is not reported to the Bureau. 

The members simply send in the codes, 
which will give a general idea of the sig- 
nificant medical or non-medical facts they 
have learned. By having this information 
available, underwriters thereafter will 
know that past problems existed when a 
subsequent application or inquiry is re- 
ceived. 

Most applications ask questions concern- 
ing any record of previous applications, 
and there are, of course, other ways 
whereby a company can sometimes find out 
the underwriting action of other com- 
panies, if this is thought to be necessary. 
They cannot, however, learn this through 
the MIB; company action is simply not 
shown in the Bureau's records. 

Maintaining Accuracy 

Great stress is laid on identity, accuracy, 
and correctness in submitting and print- 
ing reports. The Bureau follows a series 
of checking procedures aimed to produce 
correct copy. Very seldom does a printer's 
error, or mistake of identity, occur. Avoid- 
ance of this type of error is not an easy 
task, because the Bureau's service office is 
not given the key to the symbols; the work 
of printing and editing must be done 
without knowing the meaning of what is 
being handled. 

It should be noted that all MIB infor- 
mation is not of a debit or negative nature. 
Frequently, the codes will indicate the 
results of favorable tests, and this should 
help in placing the risk if further applica- 
tions are submitted. For example, favor- 
able EKG's and X-rays are reported and 
also the results of favorable glucose toler- 
ance tests. The presence of a report of such 
a test will often expedite underwriting. 

If an impairment has been reported 
present by a company and on subsequent 



examination, by the same company or by 
another, it is found no longer present, then 
the Bureau's rules require that this fa- 
vorable result should also be reported to 
the Bureau. This is sometimes referred 
to as "clearing the record." By "clearing," 
it is not meant that the old information is 
eliminated. What is left, after such an 
entry, is both the old and the new infor- 
mation. Although it very rarely occurs, if 
information shows that the old entry was 
based on incorrect data, the reporting 
company is required to correct the record. 

Reporting companies are encouraged to 
make available their findings to attending 
physicians, on request of the individual. 
Although disputes in this area can arise, 
they are infrequent, possibly because we 
try to handle medical matters through and 
with medical people. 

As to use of MIB information in the 
home office, I emphasize that it is not 
given to the members without limitations. 
Under the mutual agreement which all 
the companies are pledged to observe, 
MIB information is to be used as a flag of 
warning and as a supplement to the mem- 
ber's own underwriting investigation for 
personal insurance or claims thereunder. 

Under Bureau rules, no application can 
be declined, rated, or restricted solely be- 
cause of an MIB entry. This does not 
mean that a medical examination must al- 
ways be asked for; in some circumstances 
it may be an attending physician's state- 
ment, or a credit report, or other back- 
ground information. It does mean, how- 
ever, that each member must make its own 
independent underwriting investigation 
and come to its own independent conclu- 
sion regarding the risk. 

MIB information is made available only 
to the home offices of member companies 
for underwriting and claims purposes. It 
is not given to government or any others 
outside the membership. Strict security is 
demanded and observed. 

This last point occasionally raises dif- 



LIFE AND HEALTH INSURANCE TODAY 



49 



faulty, especially in highly competitive 
markets. Questions are asked as to why 
the Bureau insists on the secrecy of Mill 
impairment entries. Why does the Bureau 
go through this work of pledges, codes, 
code book accounting, and all the para- 
phernalia of trying to keep such a tre- 
mendous body of information confiden- 
tial? It is done essentially for two reasons. 

First, it is a principle of confidential 
information that, unless you keep it con- 
fidential, your sources are unlikely to co- 
operate again in the future. The insurance 
business receives many items of confiden- 
tial information, which are necessary to 
sound underwriting. Sound underwriting 
means lower costs of insurance to all 
policyholders, since it insures equitable 
treatment and protects the honest from the 
few who try to conceal significant informa- 
tion. Therefore, representing the industry, 
the Bureau must protect its sources. 

Second, the information developed and 
maintained is primarily medical in nature. 
The individual himself may not know all 
the medical facts regarding his state of 
health. The Bureau's constitution provides 
that the MIB must protect not only the 
interests of the insurers and other policy- 
holders, but also the interest of the appli- 
cants. 

The Bureau, therefore, is in a difficult 
area. It is possible that the applicant may 
be suffering from a serious disease and his 
physician may not have told him. It is 
possible that the applicant knows he has 
something wrong with him, but his busi- 
ness associates do not. To protect the in- 
dividual's interest, the information about 
him must be kept confidential. 

An individual with an MIB record will 
always receive careful consideration, and 
the action of one member does not de- 
termine that of others. Each company is 
entitled to reach its own underwriting de- 
cision with all known facts in view. This 
is all the MIB seeks to attain. 

In the final analysis, I believe the Bu- 



reau, as part of the life insurance in- 
dustry, participates in a great work, I 
think our business helps good people meet 
their responsibilities, as individuals, in a 
simple, economical manner. It would be 
naive to believe that there are not some 
around, who would just as soon see other 
people shoulder their burdens. 

The MIB makes its contribution by 
trying to assure that each application will 
be evaluated on the facts. The Bureau is 
not infallible. Undoubtedly, there are 
situations which are missed. But if the 
Bureau did not exist, one of two things 
would surely occur, and probably both: 
either more lengthy and costly under- 
writing procedures would be adopted or 
mortality rates would rise sharply. In both 
situations, it would be the honest policy- 
holders who would be bearing the brunt 
of the increased cost. 

As to the future, we see the Bureau as 
continuing to perform a useful underwrit- 
ing function for many years to come. We 
have been in existence since the 1890's; we 
have moved with the times insofar as re- 
organizing our procedures is concerned; 
and we have been favorably examined by 
state insurance authorities during the past 
twenty years. 

But we do not see this underwriting 
function as being enough. With the future 
developing use of computers, we see it as 
probable that the vast storage of medical 
information available to life insurance 
companies (either through their life or 
health insurance activities) can somehow 
be made helpful to medical research. We 
are not sure how, at this point, and we 
are not now on a computer, but we are 
hopeful, and we are working in this area 
with some of the best minds in the business 
consulting field. 

Several research projects have already 
been conducted with Bureau assistance, 
and here I refer to studies of diabetics by 
Dr. Goodkin of the Equitable, of EKG's 
by Dr. Singer of New England Mutual, 



50 



A SURVEY FOR THE PRACTICING PHYSICIAN 



and also of EKG's by Dr. Mathewson of 
the Great-West in Canada. 

As you know, medical research, medical 
knowledge, and medical practice are all 
moving — and moving fast. It is the intent 
of our industry to play a part in some of 
these matters, and we believe our Bureau 
will have a good contribution to make to 
this effect. 

Conclusion 

In conclusion, I would emphasize a 
point that I have not previously made. The 
basic ingredient woven into the warp and 
woof of this institution is the continued 
interest and guidance of the company 
medical directors. We know that, if we did 
not seek the highest professional standards 
for the confidential care of this informa- 
tion, our industry could not underwrite as 
economically and as efficiently as it has. 
We appreciate the cooperation that has 
existed to such great extent between our 
medical directors and their brethren in 
the medical profession. 

Finally, as a "carry-away," I summarize 
the points that I have tried to make: 

1. Life insurance is a device whereby 
responsible people may join together 
to share the burden of the risk of 
death. 



2. In any sharing, the burden must be 
fairly and intelligently allocated; 
otherwise, people would not join 
therein. In large measure, the success 
and growth of the life insurance busi- 
ness has been a result of its fulfilling 
this requirement. 

3. Knowledge of prior health history is 
essential to any such allocation. 

4. The MIB helps meet this need, and it 
is organized in a reasonable fashion 
to protect the proper interests of all 
concerned. 

5. We see a future in which large medi- 
cal data banks, such as MIB, may 
become of use to medical research, 
at the same time maintaining the 
anonymity of the individual. We are 
working to develop this possibility 
and are hopeful of favorable results 
which should appear in the middle or 
late 1970s. We, in the Bureau and 
our industry, are trying to move for- 
ward with the rapidly developing 
changes that are occurring both in 
medicine and in the techniques of 
handling tremendous amounts of in- 
formation. The picture is not yet 
clear, but I am optimistic as to the 
future. 



Clinical Versus Insurance Medicine — There Is a Difference! 



(Dr. Simmons) Our next speaker is Dr. 
D. Sergeant Pepper. Dr. Pepper was born 
in Philadelphia on May 12, 1907. Follow- 
ing his graduation in 1925 from the Haver- 
ford School, he engaged in additional study 
at the University of Pennsylvania and at 
Franklin and Marshall. In 1932, he was 
graduated from the University of Pennsyl- 
vania School of Medicine. After additional 
training in medicine, he was licensed to 
practice in the State of Pennsylvania in 
1934 and entered the private practice of 
medicine in Philadelphia. He served the 
University of Pennsylvania Medical School 
as Assistant Instructor in Medicine and as 



Ward Physician for the University of Penn- 
sylvania Hospital. In 1939, he was made 
Associate in Medicine and limited his 
practice to internal medicine, with em- 
phasis on communicable diseases. 

He served with distinction in the Army 
Medical Service during World War II and 
left active duty at the end of 1945 with 
the rank of Lieutenant Colonel. He is 
now a Colonel in the Army Reserve Corps. 

Dr. Pepper entered the life insurance 
business in January 1946 as a staff physi- 
cian of the Provident Mutual Life In- 
surance Company here in Philadelphia. In 
1946, he was made Assistant Medical Di- 



LIFE AND HEALTH INS TRANCE TODAY 



51 



rector. In L952, he joined the Connecticut 
Mutual Life Insurance Company in Hart- 
ford as Assistant Medical Director and has 
served successively as Associate Medical 
Director, as Medical Director and, since 
1965, as Senior Medical Director. 

He was Vice President of the Association 
of Life Insurance Medical Directors of 
America in 1962 and President dining the 
year 1963. 

He is an Alumni Trustee of the Uni- 
versity of Pennsylvania, a Fellow of the 
American College of Physicians and a past 
Fellow of The College of Physicians of 
Philadelphia. 

It will be of interest to this audience 
that in 1950 he was elected a Delegate to 
the Pennsylvania State Medical Society 
from Philadelphia County Medical Society 
for a two year term. 

In the early 1950's, Dr. Pepper was on 
the original committee that proposed and 
drafted the constitution for the Board of 
Life insurance Medicine. He was certified 
by this Board in 1952 and became its 
Chairman in 1957 and 1958. 

He has been a member of the Hartford 
Medical Society since 1954 and has been 
its Treasurer from 1959 until the present. 
He is a member of the Professional Educa- 
tion Committee of the American Cancer 
Society and serves on the Board of Di- 
rectors of the Mount Sinai Hospital As- 
sociation. 

It is a pleasure to introduce Dr. D. 
Sergeant Pepper who will speak to us on 
the subject, "Clinical Versus Insurance 
Medicine — There Is a Difference!" 

(Dr. Pepper) Drs. Wood, Mendell, Sim- 
mons, members of The College of Physi- 
cians of Philadelphia and the Philadel- 
phia County Medical Society, and guests 
— I might almost say "Family," — because 
my wife has been kind enough to come 
here today, and I see my revered Uncle 
Perry looking down upon me from the 
gallery up there! I am very honored to 
have been asked to appear on this pro- 



gram and I'm very happy to be back here 
in my native city. Although I have been 
away from Philadelphia for twenty-two out 
of the last twenty-eight years, I still feel 
very much at home. I was a member of 
both of your societies many years ago 
and attended many meetings in this hall 
and over at your auditorium at Twenty- 
first and Spruce Streets. I don't believe I 
abused the privilege of being at the po- 
dium very often in those days and I trust 
that I won't be too long on this occasion. 

After I left Philadelphia ami went to 
Hartford in the insurance business, I 
found I was still close enough to Phila- 
delphia so that I could return frequently 
and I have been very glad to have had 
that opportunity. 

Although I am very pleased and honored 
to be on this program with so many dis- 
tinguished gentlemen, I am not happy 
about the title assigned to me. I do not 
know who chose it and I hope that 
Vaughan Simmons will not tell me after 
the meeting that I did! 

However, the choice of the word "versus" 
was unfortunate. The first meaning of 
versus is as it is used in law or sports and 
suggests a conflict of one side against an- 
other. This is certainly not what we want. 
The second meaning of the word is 
"considered as the alternative of," as in 
free trade versus tariffs. This again does 
not apply, except perhaps when one de- 
cides to take up insurance medicine as an 
alternative to a job in clinical medicine. I 
would hate to think that a seriously ill 
patient might consider insurance medicine 
as an alternative to clinical medicine. That 
might be disastrous. 

So I ask you to forget the printed title. 
I want to talk about clinical medicine and 
insurance medicine, their similarities and 
their differences. 

But first I had better give you a brief 
introductory lesson in life insurance in 
order that you may have a better under- 
standing of the nature of our work. 



52 



A SURVEY FOR THE PRACTICING PHYSICIAN 



Basically, insurance medical directors are 
interested in long-term prognosis of dis- 
ease so that purchasers of insurance may 
secure financial protection against life's 
uncertainties for themselves and their 
families at a price that is consistent with 
the risk involved. 

Life insurance is like fire and casualty 
insurance. The price of the insurance 
varies with the risk. For example, fire in- 
surance on a frame house in the country a 
long distance from any fire department will 
cost more than insurance on a fireproof 
building with installed sprinkler system 
just down the street from the firehouse. 
Likewise, an applicant for life insurance 
with a rheumatic mitral stenosis or diabetes 
has to pay more for his insurance than 
an individual in perfect health. 

Up until the end of the last century, 
applicants for life insurance were either 
accepted at standard rates or declined. 
Often the decision was made more on an 
applicant's appearance than on a true 
medical evaluation. In the late 1890's, how- 
ever, Mr. Arthur Hunter, Actuary, and 
Dr. Oscar Rogers, Medical Director, both 
of the New York Life Insurance Company, 
devised a numerical system by which ap- 
plicants could be classified so that people 
with medical impairments could be in- 
sured at equitable rates. The numerical 
system is based on the assumption that 
healthy individuals have a mortality that 
may be represented by the percentile 100, 
which is equated from a combination of 
height, weight, age and sex. In actual 
practice, the percentile 100 is a modal 
figure. Negative and positive values are 
added to or subtracted from this figure. 
Thus the applicants referred to above with 
rheumatic heart disease and diabetes 
would have a numerical addition to the 
basic 100 percent. A credit, or minus 
value, might be associated with a favorable 
physique or with longevity in the family 
history. The final classification, which is 
the algebraic summation of the debits and 



credits, is a percentile which represents the 
underwriter's opinion of the mortality risk 
in terms of a previously determined stand- 
ard. In actual practice, this is but a guide 
or framework. There is always an added 
element of judgment. 

At age 40 in normal healthy people, we 
average four deaths per 1000 in the next 
year, a figure which is taken from our 
mortality tables. This then is the "stand- 
ard" or 100% mortality. If six deaths oc- 
cur, we have 150% mortality, eight deaths 
200% mortality, etc. We speak of "stand- 
ard" cases when the anticipated mortality 
is below 130% and "rated" cases when 
we expect the mortality to be above this 
figure. In most companies, the standard 
class runs from 85% to 130%. Substand- 
ard classes may reach as high as 1000% 
and rarely even higher. Most companies 
have a ceiling of 500%. 

In addition to the debits which are de- 
termined for medical reasons, there are 
debits which may be assessed for other 
reasons such as occupation, hobby, morals, 
habits, finances, etc. As the reasons for a 
rating or declination are not always able 
to be discussed with an applicant, he may 
unjustly blame his misfortune on the 
medical examiner or the personal physi- 
cian's statement. When information, 
whether medical or otherwise, is obtained 
from confidential sources, we cannot, of 
course, discuss the substance of the infor- 
mation or the source with the applicant. 

Needless to say, once a rating has been 
decided upon and the applicant accepts 
the policy and pays his premium, the in- 
surance company cannot increase the rat- 
ing no matter whether his health deterio- 
rates or he decides to become an astronaut. 
On the other hand, many ratings are 
removed or reduced for improvement in 
both medical and other conditions. 

It is obvious that there must be many 
similarities between insurance and clinical 
medicine. We all start with the same train- 
ing and have to go over the same hurdles 



LIFE AND HEALTH INSURANCE TODAY 



53 



to be licensed to practice medicine. Many 
of us have had experience in the clinical 
practice of medicine before entering in- 
surance medicine. In general terms, our 
problems are much the same: developing 
and interpreting history, physical findings 
and laboratory tests in order to reach a 
diagnosis. 

We differ, however, in how we get the 
necessary information to reach a diagnosis 
and what we do once the diagnosis is 
made. 

In most instances, the clinician is deal- 
ing with a patient with symptoms or with 
an obvious disease process. The patient 
wants relief and is more than willing to 
cooperate in any way to help his doctor 
arrive at the proper diagnosis. The physi- 
cian thinks in terms of this one individual 
and does his best to diagnose the trouble 
and give proper treatment. He may rea- 
lize that there is an immediate or even 
remote threat to life, but if he is giving 
the best treatment available his mind does 
not dwell on the mortality significance 
of the illness as he feels this is beyond his 
control. 

I also believe that the average clinician 
thinks in terms of pathology, rather than 
in terms of years of survival. For example, 
in a patient with repeated attacks of 
pyelonephritis, he is concerned over the 
development of chronic pyelonephritis and 
eventual kidney failure. He visualizes the 
progressive kidney damage and does all he 
can to prevent it, but he does not think 
of this disease process in terms of the 
average number of years of life remaining. 
After all, rarely can one predict the course 
of disease in any one patient and, perhaps 
in a year or two, the outlook will change 
and a more accurate prognosis can be 
given. 

In life insurance medicine, we deal with 
applicants who are presumably healthy. 
This is borne out by our statistics which 
show that 90% of applicants for life in- 
surance are issued standard policies. The 



other 10% have some significant medical 
history or some medical condition at the 
time of application. Less than 2% are de- 
clined, and the remainder are either issued 
a rated policy or fail to complete their 
application. The latter, perhaps 3%, are 
probably scared off by the prospect of 
paying a large extra premium or of having 
to undergo some further medical examina- 
tion requested by the insurance company. 

Our medical histories come to us from 
thousands of examiners based in every 
state across the country. Our medical his- 
tory forms are familiar to many of you. 
The questions are stereotyped and very 
general in nature. The applicant feels no 
compulsion to give any more information 
than necessary. We are dependent upon 
our examiners to develop points of in- 
terest. The illness or operation that may 
be of importance is often two or more 
years prior to the date of the examination. 
As you well know, the human mind tends 
to forget the unpleasant facts of illness 
and to recall only the favorable ones. 

This is why it is just as important for 
us to obtain records of former illnesses, 
details of surgical procedures and patho- 
logical reports of removed tumors as it is 
for you in your care of a new patient. Not 
all patients are told that they have had 
cancer, and not all patients are given an 
accurate account of their blood pressure 
fluctuations. Yet, I am sure, that you will 
all agree that both of these facts may alter 
longevity. 

Our physical examinations are also not 
as complete as we would prefer to have 
them. Rectal and pelvic examinations arc 
not required nor are ophthalmoscopic 
examinations of the eye or palpation of 
the peripheral pulses. Routine labora- 
tory work is limited to a test for albumin 
or sugar in the urine for the smaller case 
and urinalysis, chest X-ray and EKG for 
the larger amounts. Many of these omis- 
sions are forced upon us by competition. 
If one company decides that life insurance 



54 



A SURVEY FOR THE PRACTICING PHYSICIAN 



can be written without financial risk by 
omitting the rectal examination, other 
companies may have to follow their ex- 
ample. Life insurance agents or salesmen 
learn very quickly which company has the 
fewest requirements. They then take their 
business to this company. 

As medical directors we must review this 
somewhat abbreviated history and physical 
and decide whether we can approve or 
decline the application. Frequently we 
need further information. This may mean 
a report from the personal physician, a 
sigmoidoscopy, X-ray or laboratory study. 
Here again we may be limited in the ex- 
tent of our investigation. We can only 
spend a certain number of dollars for 
medical investigation per $1,000.00 of life 
insurance without jeopardizing the com- 
plicated premium structure. We also have 
to limit our laboratory studies to those 
tests that have no risk involved to the 
applicant. Cardiac catheterization or coro- 
nary angiography are hardly indicated. 
Even the B.S.P. test is considered too risky 
in many comapnies. 

We have, of course, other sources of in- 
formation. Dr. Reynolds, in giving Mr. 
Wilberding's paper, has described the 
Medical Information Bureau. While we 
cannot use this information as a basis for 
declining or rating an applicant, it often 
gives us a check on whether the applicant 
has given us an accurate history. If it does 
not agree with the history, we have an 
opportunity to re-examine or re-question 
him in order to confirm the MIB data. 
We can also review the business inspection 
report that may contain items of past ill- 
nesses or operations. In large cases, the 
inspectors may interview the applicant or 
his wife, his neighbors, business associates, 
local merchants and druggists. It is sur- 

Insurance Forms — Probk 



prising how much medical information is 
obtained. 

Finally, we must classify each applicant 
into a standard, rated or declined cate- 
gory. After that, his individuality is lost 
for he is only a part of a large cohort. 11 
we have classified him correctly, it does 
not matter to the company if he dies 
sooner or later. The group, as a whole, 
will give us the expected mortality rate. 

In summary, then, physicians both in 
clinical and insurance medicine are evalu- 
ating much the same information in order 
to treat the physical and financial troubles 
of their clients. The two specialties of 
medicine do have differences, however. 

The clinician can follow a patient and 
re-evaluate his diagnosis over a period of 
time. The insurance medical directors 
must reach a firm decision within a rela- 
tively short time and can only change this 
decision later in favor of the applicant. 
The clinician has the health of his patient 
and, to a small extent, his reputation at 
stake. The medical director has huge 
sums of money at stake. Every day he acts 
on many individual lives for amounts of 
$100,000.00 or more and not infrequently 
lives are insured for multiples of 
$1,000,000. 

With these large sums, all sorts of pres- 
sures are brought to bear on him to give 
a standard policy or squeeze the applicant 
into a more favorable class. He must steer 
an accurate and prudent course, for some 
very large companies, as well as small ones, 
have gotten into financial difficulties 
through too lenient underwriting. Too 
strict evaluation is almost as bad, as this 
drives business to other more competitive 
companies. 

Those of us who are in insurance medi- 
cine find it fascinating, intriguing and in- 
tellectually stimulating. 

ins and Solutions: A Panel 



(Dr. Simmons) The next item on the These documents have become a real 
program is a panel on insurance forms, problem for practicing physicians, and 



LIFE AND HEALTH INSURANCE TODAY 



55 



we have a panel of experts here this morn- 
ing to talk about the problems and to 
give us some indication of what the solu- 
tions might be. They will tell us what has 
been done and what is currently being 
done to solve the problem. The Moderator 
of our panel is Dr. Albert Larson who has 
been, since 1962, Vice President and Chief 
Medical Director of The Travelers In- 
surance Company. Currently a representa- 
tive of The Association of Life Insurance 
Medical Directors to the Life Insurance 
Medical Research Fund, he has also served 
on committees for the American Society of 
Internal Medicine, Health Insurance As- 
sociation of America, the American Geri- 
atrics Association and the Connecticut 
State Medical Society. He is a member of 
the Bureau of the International Commit- 
tee for Life Assurance Medicine. He is 
certified by the American Board of In- 
ternal Medicine and is a Fellow of the 
American College of Physicians. 

Dr. R. Robert Tyson, Immediate Past 
Chairman of the Standing Committee on 
Medical Economics of the Philadelphia 
County Medical Society and a member of 
the Board of Directors, is another of our 
panelists this morning. He is a graduate 
of the University of Pennsylvania School 
of Medicine, class of 1944, and is Professor 
of Surgery at Temple University Medical 
Center. Dr. Tyson is a member of the 
Blue Shield Corporation and a member 
of its Board of Directors. He is also a 
Delegate to the Pennsylvania Medical So- 
ciety. 

Dr. Robert S. Pressman is an internist 
and serves as Clinical Assistant Professor 
of Medicine at Temple University Medi- 
cal Center. He is a graduate of Temple 
University Medical School, class of 1937. 
He is Attending Physician, Preventive 
Medicine and Infectious Diseases Section, 
at Einstein Medical Centers and is on the 
staff of Germantown Hospital. He is a 
Delegate to the Pennsylvania Medical 
Society, a member of the Insurance Re- 



view Committee and the Subcommittee on 
Infectious Diseases and Heart and Cir- 
culatory diseases of the Philadelphia 
County Medical Society. As noted on your 
program, he is also President of the Penn- 
sylvania Society of Internal Medicine. 

Dr. Walter A. Reiter, Jr., the third mem- 
ber of our panel, is Vice President and 
Medical Director of The Mutual Benefit 
Life Insurance Company of Newark. He 
had his undergraduate work and received 
his medical degree from Cornell Univer- 
sity, the latter being conferred in 1947. 
He practiced internal medicine both in the 
United States Navy and in private practice 
with a particular interest in respiratory 
diseases. Until 1959, when he became 
associated with The Mutual Benefit Life 
Insurance Company, he had been in the 
private practice of medicine. He became 
Assistant Medical Director, Associate Medi- 
cal Director, Medical Director and, in this 
past year, Vice President and Medical Di- 
rector of The Mutual Benefit. He has served 
on the Executive Council of the Association 
of Life Insurance Medical Directors of 
America and on the Ad Hoc Committee for 
a uniform Part II, the part of the applica- 
tion for life insurance which is completed 
by the medical examiner and submitted 
as part of the application. Dr. Reiter is 
currently a representative of the Associa- 
tion of Life Insurance Medical Directors 
to the Life Insurance Medical Research 
Fund. I am happy to present this panel 
to you. 

(Dr. Larson) I am very honored to be 
sitting in this hallowed chair. Gentlemen, 
I welcome you to this panel which is un- 
rehearsed and unpredictable. One of the 
constant sources of irritation to the prac- 
ticing physician ever since any type of 
health or life insurance has been in exist- 
ence has been filling out a form. Life is 
getting very complicated. It makes no dif- 
ference whether it's a health claim, infor- 
mation regarding an insurance applicant, 
a workman's compensation case, or a third 



56 



A SURVEY FOR THE PRACTICING PHYSICIAN 



party liability case — all of these things 
require forms to be filled out and com- 
pleted by the physician to show evidence 
of proof of a loss that has occurred for 
which the individual is responsible. I see 
no way to get rid of this irritation, but 
1 think it might be possible to put some 
lype of a salve on it which would make 
it a little bit easier to live with. Our panel- 
ists will speak about this. 

Almost fifteen years ago, I served on the 
Committee of Professional Relations of 
the Medical Directors Association and 
began collecting forms that were used by 
companies. It was a rather interesting 
undertaking because some strange things 
came out. Bill McBurney, then of The 
Prudential, did the same thing and, at 
that time, he was connected with the In- 
ternational Claims Association in an of- 
ficer capacity and was able, through the 
International Claims Association and the 
Health Insurance Council, to achieve 
some degree of uniformity in health 
claim forms. Some of the questions col- 
lected were quite interesting. It says here 
on an old form, 1., "Describe fully how 
the insured is spending his time. Does he 
visit his office or place of business and, if 
he does, for what purpose?" 2., "Do you 
know anything from heresay or otherwise 
about this claimant's character, reputa- 
tion and good standing?" 3., "If the pres- 
ent address is rural, give the RFD number 
and the nearest trading point." These are 
actual questions from forms. Another: 
Has the patient or any member of his 
family ever had or received treatment for 
a specific disease during their lifetime?" 
That's quite an order! "If you adminis- 
tered any medicine to this policyholder, 
what was it? How did it affect the pa- 
tient? What symptoms have developed 
^ince the treatment began?" And as for 
the qualification of the physician, the 
question was, "What kind of medicine do 
\ou practice?" (Laughter.) Well, those 
were some of the things that we were con- 



fronted with. Now we'd like to turn the 
discussion over to our panelists. Dr. Press- 
man, why don't you begin with your 
story. 

(Dr. Pressman) I am pleased to come 
before you to tell you of the internist's 
approach to filling out these forms. I'd 
like to say at the outset that I am more or 
less of the devil's advocate when it comes 
to insurance forms. I am afraid that in- 
surance forms, like death and taxes, are 
always going to be with us. With the ex- 
pansion of insurance coverage for health 
care and the increase in comprehensive- 
ness, it is inevitable that the insurance 
company wants to know what's going on 
and to get as much information as pos- 
sible. However, the other side of the coin 
is that it becomes an increasing time fac- 
tor in the physician's office when you have 
to start processing claims for the reim- 
bursement of the patients. You can have 
your hands full in short order. I have 
seen patients come in to my office with 
as many as seven different forms following 
a spell of illness that lasted three days. 
The time involved is just simply tre- 
mendous if you have any volume of 
patients who have been sick. 

What are the problems in filling out 
these forms? Really, what you want to 
put down is the salient data: the patient's 
name, the diagnosis, the dates of treatment, 
the specific service performed and the 
charges. And that's really all that is neces- 
sary to report for the insurance companies 
to accurately know what is going on. How- 
ever, there is one problem on the diagnosis 
that I would like to bring to your atten- 
tion, and I do hope that something can be 
done about, and that is if the patient has 
carcinoma. I am sure you've all had the 
same experience where a patient had the 
form filled out and insisted on having it 
returned to him. Inadvertently, the diag- 
nosis of "carcinoma of the breast" or some 
other organ was put down. The patient 
then went into a panic, because this was 



LIFE AND HEALTH INSURANCE TODAY 



57 



the first time he ever realized that he had 
carcinoma. 

The next problem is the dates of dis- 
ability. Actually, what the insurance com- 
pany wants to know is when the patient 
stopped work and when he returned to 
work. Well, the only way that 1, as the 
attending physician, can know when he 
stopped work is to ask the patient. It's 
obvious that the insurance company can 
ask the same question and not bother the 
physician, or the insurance company can 
write a letter to the employer and get this 
information. Not only that, the patient 
can tell me anything he wants and I simply 
cannot check the accuracy of his state- 
ment, so what we are getting, in effect, is 
second hand information that is really not 
too reliable. Actually there is no diffi- 
culty in policies covering surgical proce- 
dures and there is no difficulty in those 
covering only hospitalization. The problem 
comes when the patient has disability in- 
surance which covers time out of work and 
then, of course, it becomes very important 
for the company to know how long the 
patient is actually out of work. It can be a 
problem with self-employed people. I per- 
sonally know a patient who was self-em- 
ployed who went back to work who kept 
insisting on bringing forms for me to fill 
out, stating that this was perfectly okay, that 
he had checked it with the agent and that 
the agent said there was no objection to 
this. Obviously this could not be true. 

Another thing that we find objection- 
able is the request for information con- 
cerning other policies. Again, this is fre- 
quently very difficult. We do not know of 
all the policies a patient has. The only 
way the physician can tell is if all forms 
are presented to the physician at one 
time. Then and only then is it possible 
to list all the various policies. 

Finally, let me agree with Dr. Larson's 
point about unnecessary and irrelevant 
questions which only serve to infuriate 
practicing physicians and to make certain 



that the insurance company is going to 
get inaccurate information. 

I also want to talk briefly about the 
request for information concerning in- 
surability. I believe that the average in- 
ternist tends to be too detailed, to give 
too much information. There is really onb 
some brief data, I am sure, that the in- 
surance company wants. In order to as- 
semble this brief data, it sometimes is 
necessary to do a very extensive search of 
the records, and this can take a consider- 
able period of time. This is especially true 
for a patient that you have been creating 
for a number of years. One has to find the 
dales the patient was seen, the diagnosis, 
lab data, X-ray reports, electrocardiograms, 
etc. This can really become very difficult 
I'd like to make some suggestions toward 
its solution. Because of the time facto: 
in making out forms, it might help to 
defray the physician's costs with some 
small compensation. I don't know 
whether this is heresy or not, but a physi- 
cian has to employ a secretary whose onl\ 
job is to fill out insurance forms. If the 
insurance companies in some way could 
help to defray the costs in these policie> 
where the reimbursement is going to a 
patient, this might be helpful. 

I think that as far as the cancer problem 
is concerned, the solution would be to 
put "diagnosis on file." If the insurance 
companies would accept this, then they 
could write to the physician directly. He 
could then send the correct diagnosis 
back, such as "carcinoma of the breast." 
In this manner, trouble could be avoided 
and it would certainly assist in keeping 
patients from getting terribly upset. 

Regarding insurance policies covering 
time out of work regardless of mobilit\. 
it is up to the insurance companies to se; 
a ceiling on the writing of health in- 
surance policies and allow the patient to 
collect only a certain percentage of income 
to avoid profiteering on health. How this 
can be done I don't know, but it is a 



58 



A SURVEY FOR THE PRACTICING PHYSICIAN 



tremendous problem. We have seen pa- 
tients who have a really tremendous 
amount of health insurance and it almost 
pays them to be ill. They tend to take 
advantage of it and stay ill as long as they 
possibly can. 

If you want information about other 
insurance, perhaps it might be wise to 
have a central clearing house for all poli- 
cies. In the age of the computer, I am sure 
that this would not be too difficult. As to 
the unnecessary and irrelevant questions, 
it is quite obvious that they should be 
deleted. As to insurability, I think it would 
help if the insurance companies would 
state to the internists, at least, how de- 
tailed a report they want and what their 
underwriting needs are. Actually, I know 
very little about the underwriting needs 
of insurance companies and I would ap- 
preciate information as to what determines 
the insurability and what are your under- 
writing needs. In that way, the internist 
can give a very precise and brief report. 

(Dr. Larson) Thank you, Dr. Pressman. 
It is not only the case of carcinoma which 
presents a problem; there are also many 
cases in which psychiatrists will not give 
any information regarding a patient. How- 
ever, on the new form, you don't have to 
write down the diagnosis, but simply the 
code. This is perfectly acceptable if you 
happen to know what code you want to 
use. I might say that this is used very 
often by psychiatrists without giving any 
specific diagnosis. 

The question about other health cover- 
ages was put in, as you realize, to cover 
the problem of overinsurance. The new 
form was gone over very carefully with 
the Council on Medical Services of the 
AMA and it is a jointly sponsored form. 
If you don't know or if you don't want 
to answer this question, it's perfectly all 
right. Your information may help in this 
new coordination of benefits program so 
that we have an inkling — another source 
of information — as to whether or not he 



has other coverages. We do ask the patient, 
too, of course. 

I'd like to have Dr. Tyson continue this 
discussion. 

(Dr. Tyson) The progress that has been 
made by the health insurance group with 
uniform forms has been a great help. 
However, as has already been indicated, 
there are still many problems. They are 
still irritating and, as Dr. Pressman indi- 
cated, when you have to go back over 
records, it becomes extremely irritating. I 
find this happening when you have to go 
back over old records for some new pur- 
pose such as applying for life insurance. 
I often find that I have to go back over 
old records if the insurance forms come 
through too late after a current illness. So 
the timing is important. 

I do want to go over some of the gen- 
eral problems, some of which Dr. Press- 
man has talked about. In the last two 
days, through my office — we don't handle 
a great many insurance forms — we had 
nine totally different forms presented to 
us. Most of these, fortunately, required 
only about seven items to be answered. 
However, some required up to fifteen 
items to be answered. It is difficult for 
secretarial help to understand the 
various implications and get the proper 
answers down. With all of us, our secre- 
taries do most of the work and we check 
and sign the forms. We are troubled with 
repetitious filing. We have some patients 
who come in with the same form of seven 
or ten items that supposedly have to be 
answered every week because the patient 
is still convalescing and out of work. It's 
rather ridiculous. Every now and then we 
rebel and decide that we are just not going 
to answer. We'll sign our name to it to 
indicate that the patient is still out and 
let the rest go because the answers are 
really the same. We really don't have the 
time to look them up again. 

One of the items that touches on com- 
ments from Dr. Pressman and Dr. Larson 



LIFE AND HEALTH INSURANCE TODAY 



59 



is the fact that most of these forms are 
single sheets, two sides, part for the em- 
ployer, part for the doctor, part for the 
hospital, and a part for the patient to 
fill out. The patient usually ends up hand- 
carrying this around because if he doesn't, 
it becomes lost in the bureaucracy of our 
hospitals. And, of course, he sees diag- 
noses and everything else that goes into 
it. Of course, one way to keep the patient 
from getting undesirable information 
about his diagnosis and other things is not 
to give him that part of the form. And 
although this type of an arrangement in 
printing may be more economical, I would 
think that some separate forms might be 
devised that also might help in prompt- 
ness of filing, because I can't work on a 
form if the hospital has it and vice versa. 

I would like to suggest further work on 
uniform forms. Trying to get agreement 
on one standard form would be highly de- 
sirable for all of us, a form that would 
require the transference of routine infor- 
mation the least number of times. Is it 
necessary to put down age to help in 
identifying a patient if there happen to be 
two members of a family? I suppose we 
have to get back to using numbers to 
identify people, and I suppose that some 
items of this sort might be the simplest 
solution provided that we have to con- 
tinue filling out forms in this fashion. 

I would like to suggest that there be a 
central cooperative center based on a 
computer, using an identity card such as 
the various charge services issue, that 
not only woidd store data but would 
identify the individual directly from the 
card. It could be done by a machine and 
transcription would not be necessary. A 
telephone service could telephone in the 
information; coding could be done im- 
mediately from the office. You could get 
immediate verification in all instances 
whether this particular person is covered 
for this field or whether this particular 
person is not covered and whether the in- 



surance is applicable. One of the major 
problems to be worked out with this sort 
of system is how to maintain the confi- 
dentiality of the information. But with 
the complexity that we seem to be moving 
into, I don't think there is any question 
that ultimately this is the type of opera- 
tion that is needed. Obviously if we are 
going to maintain our private enterprise in 
providing health care, we have to be able 
to compete with a centralized organiza- 
tion and unless we, the physicians, and all 
of the insurance companies band together, 
I don't see how we can provide as inexpen- 
sive care as some other large central agent. 

I once sat down to lunch with the ne- 
gotiator for Canadian Steel Unions. We 
were talking about this problem, and I 
said, "Why are you so much in favor of 
governmental health insurance?" He said, 
"Why, this is big business. We must know 
ahead of time how much it is going to 
cost our members so that we can negotiate 
properly in our contracts. We have to have 
one central agent to deal with; we can't 
be dealing with half a dozen. Do you 
know any other organization that is big 
enough, hires enough people and has 
enough prestige to provide this?" A pretty 
tough question to answer when we have 
our health care fragmented the way it is. 
I think we must get together. 

(Dr. Larson) Thank you very much, Dr. 
Tyson. I think we are all intrigued, in this 
age of cybernetics, with the use of a com- 
puter. In Hartford, we have been check- 
ing into how this can be done. IBM is 
doing this in their clinical decision support 
system to a certain degree. Of course, all 
we're talking about is gathering informa- 
tion, and that's exactly what a computer 
can do. Perhaps someday all vital statis- 
tics will be on a computer. I'm not so 
sure that I want this, but maybe we won't 
have much of a decision as to whether or 
not we will be on a computer. 

(Dr. Reiter) There have been some very 
significant questions posed here today. I 



60 



A SURVEY FOR THE PRACTICING PHYSICIAN 



would like to be firm and state that we 
loo realize the difficulties involved with 
health insurance forms. Dr. Larson has 
been one of the members who has been 
very active, as have many of the other 
men here at one time or another. In this 
form situation, the Health Insurance 
Council has done a rather massive job, as 
Dr. Larson mentioned briefly, to solve the 
problem. The Council has combined its 
efforts with various committees within the 
AMA and other insurance claims and 
health associations. The answers are not 
all here yet. We know that. But I think 
we have made strides. 

I was on a committee which put to- 
gether and recommended the standard life 
insurance form (Figure 1) for general use. 
Already, companies are starting to use it 
or an identical one, except for minor 
changes. You have heard mentioned that 
there are some 1,700 life insurance com- 
panies in the industry. Perhaps the top 50 
or 100 do most of the business throughout 
the country. Every time that somebody 
tries to coordinate or put together a com- 
mon form which will be used by many 
companies, the easier it becomes for the 
physician to do the job. I will not go 
nto great detail on this except to say 
that this form was designed to simplify the 
physician's reporting of a medical history. 

Dr. Pepper has done an excellent job 
in discussing the relationships between 
clinical medicine and life insurance medi- 
cine. Gentlemen, you must realize that 
we too have the assignment to obtain a 
certain amount of information so that 
decisions and determinations can be made 
intelligently. 

Regarding the attending physician's 
statement, Dr. Pressman asked a specific 
question: how does one fill it out? Figure 
2 is a standardized attending physician's 
statement form which many companies 
are using. Dr. Larson and I spoke about 
this very briefly. 1 don't know whether I 
can make an accurate estimate, but perhaps 



90% of the life companies are using this 
standardized attending physician's state- 
ment form. I think we could take a lot of 
time to try to answer how the physician 
should fill it out. We are not asking him 
to make a determination as to this man's 
insurability. The applicant typically does 
not know the details of his medical his- 
tory and may not recall that he had some 
medical care. We are interested in a sum- 
mary of the pertinent points. For a general 
complete physical examination, we don't 
expect a complete run-down of all of the 
facts and figures. A summary of the posi- 
tive findings, diagnosis and treatment 
would suffice. Each company represented 
in this room and perhaps throughout the 
country may have somewhat different re- 
quirements within its own organization as 
to how it would interpret the statement, 
but basically we are looking for a simple 
summary of the medical history. 

Other forms cause the greater difficulty 
for the clinician. Dr. Larson and Dr. Ty- 
son mentioned the combined form recom- 
mended by the Health Insurance Council 
and the AMA. This is a more recent coali- 
tion of the reporting of the claims, be they 
major medical or disability income type 
claims. The aim of the Health Insurance 
Council and the AMA organizations that 
worked with the insurance industry was 
to produce a form which would be simple 
and better than the one which we had. I 
dare say that this might be simplified 
further if we kept working. This appears 
to satisfy better the increasing use of 
electronic data processing in business ac- 
counting. In this all-purpose Comb 1 (Fig- 
ure 3), the components possibly could be 
made more responsive to changing atti- 
tudes of the medical profession. We are 
still working to find better ways to solve 
the physician's problem of coping with 
seven to nine different forms in one day. 

I'd like to ask Dr. Larson whether the 
physician has the election, of using and 
returning the HIC approved form? 



LIFE AND HEALTH INSURANCE TODAY 



61 



TO THE BLANK LIFE INSURANCE COMPANY 



Proposed Insured 



First name 



Middle miiml 



Laat name 



Birth Date: 



Moniti 



Day 



Yonr 



a. Name and address of your personal physician? . 
(Ij none, so state) 

b. Date and reason last consulted? 



c. What treatment was given or medication prescrihed?- 



Yes No 
□ □ 

feet, paralysis or stroke; mental or nervous disorder? □ □ 
Shortness of breath, persistent hoarseness or cough, 
blood spitting; bronchitis, pleurisy, asthma, emphy- 
sema, tuberculosis or chronic respiratory disorder? 



Have you ever been treated for or ever had any known 
indication of: 

a. Disorder of eyes, ears, nose, or t hroat? 

b. Dizziness, fainting, convulsions, headache; speech de- 



d. Chest pain, palpitation, high blood pressure, rheu- 
matic fever, heart murmur, heart attack or other disorder 
of the heart or blood vessels ? 

e. Jaundice, intestinal bleeding; ulcer, hernia, appendi- 
citis, colitis, diverticulitis, hemorrhoids, recurrent in- 
digestion, or other disorder of the stomach, intestines, 
liver or gallbladder? 

f. Sugar, albumin, blood or pus in urine; venereal dis- 
ease; stone or other disorder of kidney, bladder, pros- 
tate or reprodu c tive organs? 

g. Diabetes; thyroid or other endocrine disorders? 

h. Neuritis, sciatica, rheumatism, arthritis, gout, or dis- 
order of the muscles or bones, including the spine, 
bac k, or joints? 

i. Deformity, lameness or amputation? 



j. Disorder of skin, lymph g l a nds, cyst, tumor, or cancer? 
k. Allergies; anemia or other disorder of the blood? 
E Excessive use of alcohol, tobacco, or any habit-form- 
ing drugs? 



□ □ 

□ □ 

□ □ 



□ □ 

□ □ 



□ □ 

□ □ 

□ □ 

□ □ 

□ □ 



3, Are you now under observation or taking treatment? □ □ 



4. Have you had any change in weight in the past year? □ □ 

5. Other than above, have you within the past 5 years: 

a. Had ar.y mental or physical disorder not listed above? □ O 

b. Had a checkup, consultation, illness, injury, surgery? □ □ 

c. Been a patient in a hospital, clinic, sanatorium, or 

other medical facility? □ □ 

d Had electrocardiogram, X-ray, other diagnostic test? □ □ 
e. Been advised to have any diagnostic test, hospitaliza- 
tion, or surgery which was not completed? □ □ 



6. Have you ever had military service deferment, rejection 

or discharge because of a physical or mental condition? □ □ 

7. Have you ever requested or received a pension, benefits, 

or payment because of an injury, sickness or disability? Q □ 

8. Family History : Tuberculosis, diabetes, cancer, high blood 
pressure, heart or kidney disease, mental illness or suicide? □ □ 



Father 



Mother 



Brothers and Sisters 

No. Living 

No. Dead 



Age if 
Living? 



Cause of Death? 



Age at 
Death? 



DETAILS t v.- an wow (IDENTIFY QUESTION 

M MMER, CIKCI.l. APPLICABLE ITEMS: Include 
diagnoses, dates, duration and names and addresses of all 
attending physicians and medical facilities.) 



Females only: Yes No 

a. Have you ever had any disorder of menstrua- 
tion, pregnancy or of the female organs or 
breasts? □ □ 

b. To the best of your knowledge and belief are 

you now pregnant? fj D 



(THIS SPACE FOR INDIVIDUAL COMPANY USE) 



Fic. 1. The standard life insurance form. 



62 



A SURVEY FOR THE PRACTICING PHYSICIAN 



Complaints and abnormal 
physical findings 



Dates attended 
Month Year 



Duration 
of illness 



Diagnosis 



Describe treatment 
or operation 



2 Laboratory Find.rgs (including x-ray, ECG, BMR and pathological reports, etc. with dates) 



3 Present condition, if known? (include sequelae and complications of above reported illnesses) 



4 Have any other physicians or surgeons been consulted? II so, please give name, date, and nature of disorder. 



5 Please record any other information which might have a bearing on this person's hsalth. 



Form approved by 
Council on Medical Service 
AMA, Doc. 1959 



THIS FORM MUST BE SET-IT DIRECTLY TO THE HOME OFFICE 



Date „ (Signature) 



M. D. 



Fic. 2. The standardized attending physician's statement form. 



(Dr. Larson) He does. One of the things 
that we advocate is that if you get a 
case such as the one you were describing 
with nine different forms, it is perfectly 
acceptable to utilize the Comb 1 form for 
all nine. Another question that has come 
up here is the question of payments. It 
has been stated by the American Medi- 
cal Association, as a matter of policy, if 
I'm not wrong, Dr. Dorman, that no pay- 
ment shall be made for the first completion 
of a claim form. The government is not 
going to pay for it, and the insurance in- 
dustry is not going to pay for it. Now if 
additional information is needed to evalu- 
ate the case, then frequently we do pay 
for that additional information, especially 
if the doctor requests it. It has been a 
policy of our Association that there should 
be a reasonable payment made for infor- 
mation requested for underwriting pur- 



poses. I might mention in regard to attend- 
ing physician's statements (which the 
agents hate, I think, more than you do) the 
fact that some companies are utilizing a 
24-hour, seven-day-a-week telephone serv- 
ice which allows you to pick up the tele- 
phone any place in the United States 
and call this information in and dictate it 
on a tape such as we are using here. 

There is a commercial which sells some 
kind of new cigarettes which says, "You've 
come a long way, baby I" I think we have 
come a long way, but we haven't gone all 
the way. We think we have to continuously 
work, and the committees are continu- 
ously working, on this matter of forms. 
We want them to be as simple as possible 
but you must realize that we have to have 
certain proofs in order to pay out policy- 
holders' money. We try to keep the matter 
as simple as possible. The points that both 



LIFE AND HEALTH INSURANCE TODAY 



63 



HEALTH INSURANC E CLAIM - CROUP OR INDIVIDUAL 
PART A 



■ I I (10 « 



TO BE COMPLETED BY PATIENT (INSURED) 

Spaced for Typewriter — Marks for Tabulator Appear on this Line 



PATIENT S NAME AND AUDWM 



DATE OF BIRT 



INSURED ■ NAME IF PATIENT IS A DEPENDENT 



NAME OF INSURANCE COMPANY 



POUCV NUHIK 



INIUHOJ MQAl SECURITY HUMMER 



If OROUP insurance , name OF FOLIC V HOLDER (U§, Employer, Union ot Allocution through whom tmuttd) 



AUTHORIZATION TO TAY ItNSFITS TO PHYSICIAN: I Ixrtbf autt-Ofiia 
p*Tni .1 dlrertly to « u*id«r*lgned Phyiician of rh« Surgicjl and/or M«<Jk*l 
■«n«fift, if arty, oWwnrf M pjyshi* to m« for hit MrvtCW M d«tcrib«d b«'ow 
but not >o Ric*«d HM roaionabU And ci/ltom»ry eSarga tor thoi* ltnriew. 



► 



• IONED (INSURED PERSON. 



AUTHORIZATION TO RELEASE INFORMATION: i hi -by a-mo/iis I he 
undariignad Physician fo ril««w *r>r Information acquired in ths court* of 
my eiemlnjtion of tr«»fmtnt. 



SIGNED (PATIENT. OR PARENT IF MINOR) 



PART B 



ATTENDING PHYSICIAN'S STATEMENT 



t. DIAGNOSIS AND CONCURRENT CONDITIONS 

(IF DIAGNOSIS COOK OTHER THAN ICOA* USED. GIVE NAME I 



2. IS CONDITION DUE TO INJURY OR SICKNESS ARISING OUT OF PATIENT'S EMPLOYMENT I 

V„ □ NO □ 



pregnancy t 

:. □ no □ 



IF YES. APPRO 1 1 MATE DATE 
PREGNANCT COMMEKCCO. 

DATE 



DESCRIPTION OF SURGICAL OR MEDICAL SERVICES RENDERED 



jO— Doeter'i OfTicE 
H— Patient's Horns 



I H — Inpatient Hospital NH — Nursing Horn* 

OH— Outpatient Hospital OL— Othsr Location* 



^XSSR? *rCDA — 'ntenwtional Classification of Diseasos 

••CPT — Currant Procedural Terminology (current edition) 



TOTAL CHARGES P> S . 
AMOUNT PAID P> S . 
BALANCE GUI ► S 



4. DATE SYMPTOMS FIRST APPEARED OR ACCIDENT HAPPENED. 



5. DATE PATIENT FIRST CONSULTED TOU FOR THIS CONDITION 



6 PATIENT EVER HAD 6AME OR SIMILAR CONDITION? 
YES I" NO ["J IF "YES" WHEN AND DESCRIBE! 



7. PATIENT STILL UNDER YOUR CARE FOR THIS CONDITION 7 

vet Q no Q 



0. PATIENT WAS PARTIALLY DISABLED. 



I f . PATIENT WAS HOUSE CONFINED. 



12. DOES PATIENT HAVE OTHER HEALTH COVERAGE? 
TES L NO IF "YES" PLEASE IDENTIFY 



IS. I DO NOT ACCEPT ASSIGNMENT. 

DAIE PHYSICIAN S NAME i PRINT ) SIGNATURE DEGREE TELEPHONE 



STREET ADDRESS CITT OS TOWN STATE OR PROVINCE 



MEMORANDUM REGARDING DISPOSITION OF THIS FORM ON REVERSE SIDE Approved by Council on Medial Service. .'.MA 10-67 

Fig. 3. The all -purpose CoTnb-1 health insurance claim form. 



64 



A SURVEY FOR THE PRACTICING PHYSICIAN 



Dr. Tyson and Dr. Pressman made were 
excellent ones, and I can sympathize with 
them. Now, as far as the workmen's 
compensation forms are concerned, that is 
a question of state regulation where the 
insurance industry actually doesn't have 
any control. 

As I have said, we will continue to look 
into this question and make this irritant 
a little less all the time. 

A Look at 

(Dr. Simmons) The final speaker is Dr. 
Arthur E. Brown. Dr. Brown was born 
on February 25, 1918, in Harrisburg, 
Pennsylvania. He received his A.B. degree 
at Harvard and his M.D. at Temple Uni- 
versity School of Medicine in 1943. Fol- 
lowing an internship at Philadelphia Gen- 
eral Hospital, he served in the Medical 
Corps of the U. S. Army from 1944 to 
1946, leaving the army as a major. His 
tour of duty included service as Chief of 
X-ray Service for a number of general hos- 
pitals serving Iwo Jima, Saipan, Tinean 
and Guam. 

Dr. Brown practiced internal medicine 
in Harrisburg from 1949 to 1956 when he 
joined the Medical Department of The 
New England Mutual Life Insurance 
Company as Assistant Medical Director. 
He has successively been Associate Medical 
Director, Medical Director and, since 
1968, Vice President and Medical Direc- 
tor. 

In addition to his duties at The New 
England Life, he has continued activity 
in clinical medicine and is Clinical As- 
sociate in Medicine at the Massachusetts 
General Hospital in Boston. 

Dr. Brown is a Diplomate of the Ameri- 
can Board of Internal Medicine and a 
Fellow of the American College of Physi- 
cians, the American College of Chest 
Physicians and the American College of 
Cardiology. He is a Senior Member of the 
American Federation for Clinical Research 
and a member of the American Society of 



(Dr. Simmons) Thank you very much, 
gentlemen, for this information and dis- 
cussion of these problems. It is obvious 
that we don't have all of them solved at 
this point, but there have been some sug- 
gestions made this morning that are ap- 
propriate and which will help point us in 
the right direction. Things are getting 
done and we are making definite progress. 

Automation 

Internal Medicine and the Board of Life 
Insurance Medicine. He is a member of 
the Massachusetts State Health Committee 
and the Medical Relations Subcommittee 
of the Health Insurance Council. Among 
numerous other affiliations and honors, he 
is Secretary of the Association of Life 
Insurance Medical Directors of America 
and a member of the Executive Committee 
of the Medical Information Bureau where 
he serves also as a member of the Sub- 
committee on Health Insurance and Elec- 
tronic Conversion. 

He has been spending a great deal of 
time during the past year studying auto- 
mation and is eminently qualified to give 
us this morning "A Look at Automation." 

(Dr. Brown) Let me mention those sub- 
jects which will not be discussed today. 
Certainly I have no intention of discuss- 
ing the fundamentals of computer science 
although I would quickly add that such a 
course as the one given by the American 
College of Physicians at Madison, Wiscon- 
sin, on "Computers in Medicine" was an 
excellent one and probably only the first 
of many similar courses yet to come. In 
spite of the fact that there would appear 
to be a definite relation to mortality, 
today we will not discuss the purely clini- 
cal use of computers in the practice of 
medicine, for example, the computer in the 
clinical laboratories, patient monitoring, 
the control of multiple physiological func- 
tions by the computer, hospital adminis- 
tration, doctors' order activity in a hospi- 



LIFE AND HEALTH INSURANCE TODA'Y 



65 



tal, computers in medical education, or 
jj computers in clinical research. In all of 
these fields, the computer has already 
proved its worth. Much needs to be done, 
particularly in relation to the software 
and the expense, but this is no longer 
simply a dream of the "blue sky" area. 

If one goes to the National Library of 
Medicine in Bethesda to research through 
MEDLARS the subject of "computers in 
medicine," one finds 327 articles cited 
from mid-1964 to December 1967. This 
gives you some indication of the increas- 
ing activity in this field. 

However, since the over-all subject to- 
day is a survey for the practicing physician 
of what really is taking place in life and 
health insurance at the present time, 
perhaps it's best to start by telling you a 
little more of our Association of Life In- 
surance Medical Directors, at least the 
part of it that is germane to this discussion. 

We have a number of committees. One 
of these is a committee that has changed 
with the times. It formerly had to do with 
underwriting procedures, then laboratory 
procedures, and then electrocardiographic 
criteria and problems. In 1968, Dr. John 
Pearson, the Chairman, divided what is 
now the Medical Management and Pro- 
cedures Committee into three subcommit- 
tees dealing with 1., the use of para-medi- 
cal personnel, 2., the use of EDP equipment, 
and 3., the possibility of industry-wide 
examiner panels. 

The first two of these we might discuss 
today, and if we have time a few other 
subjects will be considered. 

Dr. Simmons, I believe, was particularly 
anxious that I discuss the insurance ex- 
, amination situation as it now exists. As 
you well know, the average practicing 
physician is so very busy with his own 
practice that little time is available in his 
schedule for examining applicants for in- 
surance, let alone for the considerable 
paper work that needs to be done. Cer- 
tainly, in the past decade because of this 



time element, there has been an increas- 
ing interest in medical economics and in 
the management consultant who will ad- 
vise you as to how best to spend your time 
in the over-all effort of giving the best 
possible patient care and at the same time 
doing it efficiently enough to provide a 
proper income. 

Care of one's patients means care dur- 
ing health, and this includes preventive 
medicine; in reality, this in turn should 
embrace the field of insurance medicine, 
wherein your patient applies for life in- 
surance when there is a real need. 

Again our problem is your problem: 
time. Without going into all the reasons 
for the many troubles, the facts are that 
in a good percentage of cases there is dif- 
ficulty in obtaining an examination. The 
reactions to this situation are many, and 
all are an attempt to solve or partially 
solve this problem. 

Non-medical limits have been increased, 
possibly now as much as can be done, at 
least in today's economy. Among other re- 
actions can be listed the groups of phy- 
sicians formed in various ways and cover- 
ing geographically various areas. Such a 
group may be run by a physician or lay 
people, but in either case the idea is an 
availability factor, that is, prompt re- 
sponse to one phone call and a resulting 
examination by a physician known to and 
approved by the medical department of 
the insurance company. 

There is, for example, one such or- 
ganization in Chicago actually started by 
two insurance brokers. My last count was 
to the effect that this particular organiza- 
tion had fourteen different office sites and 
these people are opening offices in six 
additional cities. Office hours are by and 
large from 6 p.m. to 10 p.m. on weekdays 
and 10 a.m. to 4 p.m. on Saturdays. This 
particular service guarantees from one 
phone call an examination by a doctor, 
and they advertise "immediate service." 

On the West Coast there are several 



66 



A SURVEY FOR THE PRACTICING PHYSICIAN 



groups of physicians created and directed 
by physicians. One such group consists of 
33 physicians and another of 10. In one 
group the medical department of the in- 
surance company has the privilege initially 
of determining which doctors it will ac- 
cept and those whom it won't. 

I have always thought that, instead of 
being run by a doctor whom we do not 
know or even by insurance brokers as is 
the case in at least one instance, this type 
of operation could be set up in cooperation 
with a county or state medical society, the 
housing and other expenses including com- 
pensation probably being financed by in- 
surance companies. Possibly this could be 
combined with a second operation, that 
of obtaining Attending Physician's State- 
ments — the entire operation under the 
immediate direction of a physician who 
is known and respected in the area by his 
colleagues. Incidentally, I know of one 
such small operation working through a 
county medical society in Georgia. 

Then there are the so-called para-medi- 
cal examinations, and this would appear 
to be the important area in the immediate 
future. Some of these operations are run 
by physicians, some by lay individuals and 
some by investigating companies. In the 
majority of cases the principle is to do 
away with the examination in certain 
age groups and amounts and obtain a 
history self-administered or taken by a 
trained assistant. There would also be ob- 
tained certain physical findings such as 
height and weight, blood pressure and 
pulse all possibly electronically recorded; 
perhaps also other measurements as a 
timed vital capacity, electrocardiogram 
with two, six or twelve leads, a phono- 
cardiogram, blood chemistries using a 
multi-channel autoanalyzer, urinalysis, 
chest x-ray or any combination of these. 
The options would be determined by the 
age of the applicant and the amount of 
insurance applied for. 

One such organization originating in 



Kansas City now has eight offices in five 
different states. This particular organiza- 
tion offers service on an appointment basis 
from 10 a.m. to 7 p.m. during the week 
and 8 a.m. to 5 p.m. on Saturdays. They 
offer 1., completion of their history foim, 
2., height, weight, chest and waist meas- 
urements, blood pressure and notation of 
any obvious abnormalities, 3., urine for 
glucose, albumin and occult blood, 4., 
phonocardiogram of the apical and aortic 
areas, 5., 12-lead electrocardiogram, 6., 
SMA-12 chemistry screen and a hemo- 
globin, 7., timed vital capacity and 8., 
temperature — all, believe it or not, for 
$10.00. 

This type of thing is becoming big 
business. Speaking for myself only, I am 
somewhat disturbed by this mass-produc- 
tion in which we have little control. I am 
disturbed by the formation of large phy- 
sician groups and our inability to control 
the caliber of these men. I am also troubled 
by the increased problems that are bound 
to arise with the variants that one sees 
in doing multiple chemistry screening 
tests. It might be stated here that cer- 
tainly there are no good hard facts, and 
therefore no complete agreement, as to 
the "yield" and particularly cost/benefit 
ratio related to these large screening en- 
deavors. 

We have always depended heavily on the 
good practicing doctor, but in all honesty 
it must be admitted that in a large number 
of insurance applicants he is much more 
important in his report to us on his own 
patient than he is on doing a routine 
examination for insurance unless there 
are problems. It is for this reason we are 
becoming more interested in self-adminis- 
tered histories and also in the "assistant 
physician" training program at Duke 
University and other institutions. 

How then can we obtain what we feel 
is necessary for us and at the same time 
disturb the practicing doctor as little as 
possible? 



LIFE AND HEALTH INSURANCE TODAY 



67 



As you possibly know, the studies done 
on Attending Physician's Statements show 
that financially we cannot afford in most 
instances to request fewer statements. How- 
ever, it seems to me we can proceed along 
well-controlled para-medical lines. 

In addition to those we have mentioned, 
I believe, it won't be long until our his- 
tory-taking is indeed automated. You are 
aware first of the Cornell Medical Index 
and Dr. Collen's work at the Oakland 
Kaiser Permanente Group. Then comes 
Dr. Slack's work on a computer-based his- 
tory and physical examination and also 
Dr. Octo Barnett's at the Massachusetts 
General Hospital and Dr. Mayne's at the 
Mayo Clinic. Possibly there are about 
eight groups over the country working on 
this. 

Although most insurance companies 
have computers, and I suppose the major- 
ity of the larger ones third generation 
computers, we still have a way to go with 
respect to terminal devices. Certainly local 
agency offices will have them in the not 
too distant future; a few already do. On 
the other hand, doctors' offices don't, but 
again with regionalization I suspect in 
rural and semi-rural areas this will come. 
It has been predicted that within the next 
five years automated medical histories 
should be available to every physician and 
health care facility. Service bureaus will 
provide remote computer terminal service 
much as the telephone company does to- 
day. And in this area it should be men- 
tioned that the interface of man and ma- 
chine and also the computer's ability to 
respond rapidly and appropriately are 
of great importance. However, since we 
do business over such a wide geographic 
area, this problem of terminals is one of 
our difficulties. 

With respect to electrocardiograms, we 
can certainly transmit those which our 
examiners take, but this is only a small 
percentage of all the electrocardiograms 
we see. The majority are loans from the 



practicing physician, and as yet we have 
no good optical scanning device. Indeed in 
most computer processing the chief limit- 
ing factor is inadequate input techniques. 
Here in Philadelphia, Baird and Gar- 
funkel noted that the two big problems of 
input and cost loomed so large that their 
program was halted. 

At this point you might be interested in 
what one company is doing. Since 1954 we 
have been coding in great detail the elec- 
trocardiograms received by us. On the same 
card with this electrocardiographic code 
there are also coded other factors (Figures 

4 and 5). 

Mortality studies can be done, and the 
possibility certainly exists that some day 
the electrocardiogram can be underwritten 
as well as received on our computers much 
the way a computer diagnosis of an elec- 
trocardiogram is accomplished today but 
going one step further. 

I would like to say just a word more 
about this ECG program, for to my knowl- 
edge it is the most detailed long-term study 
in existence that correlates ECG, clinical 
and insurance data with the mortality of 
life insurance applicants. This study 
project was designed in 1954 by Dr. Rich- 
ard Singer who has continued to guide it 
through the tempestuous seas of machine 
problems. Last year Dr. Singer spoke 
before this group on "Comparative Mortal- 
ity and Survival Data by Medical Impair- 
ment," a study sponsored by the Associa- 
tion of Life Insurance Medical Directors. 
At this moment many man-hours and a 
moderate amount of money are being spent 
converting 30,000 ECG cards; this is one 
of the many problems one faces when one 
works with machines. 

Nevertheless, it seems to me the in- 
surance industry is in a unique position to 
do long-term studies. For example, in our 
Bundle Branch Block Study of ECG study 
cards of exposure from 1950 to 1965, only 

5 of 971 entrants could not be traced. 



68 



A SURVEY FOR THE PRACTICING PHYSICIAN 



ECG STUDY CARD 

FRONT 




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MEDICAL FACTORS 



F2 |f J 



<P-(PcO 



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ACTION 

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MEDICAL FACTORS 
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DIAGNOSIS 



WRITTEN 
COMMENTS 



COLUMNS FO-F9 
VIEDICAL FACTORS 



COLUMNS M1-M9 
ECG CODE 



Fig. 4. Electrocardiographic findings coded on a computer card. 



Other companies are doing excellent stud- 
ies in other areas. 

Much helpful information can be 
gleaned from these studies, and once the 
industry stabilizes somewhat with respect 
to machines and the data base becomes 
more readily available there will be more 
information to be obtained. 

To pursue the computer just a little 
further, in our business several companies 
are already under way in what might be 
termed "Electronic Pre-Underwriting and 
Underwriting." This system will relieve 
underwriting people of tedious and repeti- 
tive jobs in the processing of policy appli- 
cations testing them within a program and 
sorting out for an underwriter those ap- 
plications which are found to be outside 
its rules or limits. This type of procedure 
is just now in its infancy; it has a long 
and bright future although the early days 



in this venture will be filled with problems. 
In such realms as payment of medical 
examiner fees the same problems exist, but 
we are farther along in solving them. This 
is more of a bookkeeping function and 
more easily handled by the programmer 
and the computer. However, when mis- 
takes are made they are, as you know, 
"really good ones" and then come the 
public relations problems. 

And so it would appear that some day 
in the not too distant future our field of 
insurance medicine as it applies to life 
insurance will look something like this: 

An insurance agent will call on a client 
whose name he probably obtains from a 
machine programmed to certain markets. 
The agent will then obtain certain facts 
and proceed to feed these into a computer 
to produce what might be referred to as 
"electronic coordinated estates," a program 



LIFE AND HEALTH INSURANCE TODAY 



69 



ECG STUDY CARD 

BACK 



tun 



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MIS MI4 MIS 



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^0=1c03cO=t:03 = D= 

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MI8 CODE 



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CM ST UAU( til iMfOLAI (HICIU 



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ECG 12 LEADS , 

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= l = Cl3cl^P::P::i:^Pcl = Cl = C8 = ^ 



L 



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sicmiciit st [unnti nvm 
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MtllfiUIT ST DCWSVIOI 



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COLUMNS M11-M24 
ECG CODE 

(Many mult 
Fig. 5. ECG findings coded 

which will give you in hard copy a print- 
out of this client's requirements not only 
for life insurance but also for capital crea- 
tion and accumulation. 

At this point with the help of para- 
medical personnel and automated labora- 
tory equipment some type of computer- 
based history and physical examination 
will be performed with the practicing 
physician stepping in on problem cases. 
All fees will be paid out from the Home 
Office by the computer. And then the 
policy will be electronically underwritten 
and spewed out untouched by human 
hands except for that small percentage 
in which there are medical or nonmedical 
problems that the computer is not pro- 
grammed to handle. 

After this policy is issued, your agent 



13 COLUMNS 
12-LEAD ECG CODE 

iple punches) 

on a computer card (back). 

then, in hard copy form or on the visual 
display terminal in his agency, can obtain 
at a moment's notice the status of this 
policy. And so now before this is all an 
accomplished fact, we think about what 
else the future holds, and then about such 
things as the rights of the individual and 
invasion of privacy. 

(Dr. Simmons) Thank you very much. 
You have had the difficult assignment of 
being "anchor man," and I appreciate the 
fine way in which you have made your 
presentation. 

Thank you all for coming. The meeting 
is adjourned. 

REFERENCES 
I. Abramson, J. H., Terespolsky, L., Brook, J. G., 
and Kark, S. L.: Cornell medical index as a 
health measure in epidemiological studies. A 



70 



A SURVEY FOR THE PRACTICING PHYSICIAN 



test of the validity of a health questionnaire. 
Brit. J. prev. soc. Med. 19: 103-110, 1965. 

2. Association of Life Insurance Medical Direc- 

tions of America, 77th Annual Meetinc, 
October, 1968: Transactions LII. In press. 

3. Baird, H. W. and Garfunkel, J. M.: Electronic 

data processing of medical records. New Eng. 
J. Med. 272: 1211-1215, 1965. 

4. Barnett, G. O.: Computers in patient care. New 

Eng. J. Med. 279: 1321-1327, 1968. 

5. Best, W. R., Mason, C. C, Barron, S. S., and 

Shepherd, H. G.: Automated twelve-channel 
serum screening. I. What is normal? Med. 
Clinics of North America 53: 175-187, 1969. 

6. Brodman, K., Erdmann, Jr., A. J. Lorce, I., 

Wolff, H. G., and Broadbent, T. H.: The 
Cornell medical index. JAMA, 530-534, June 
11, 1949. 

7. Collen, M. F.: Automated multiphasic screen- 

ing and occupational data. Arch. Environ- 
mental Health 15: 280-284, 1967. 

8. Collen, M. F.: Automated multiphasic screen- 

ing and periodic health examinations. Pro- 
ceedings of the Medical Section of the Ameri- 
can Life Convention, 55th annual meeting, 
June, 1967. 

9. Collen, M. F.: Computer analyses in preventive 

health research. Methods of Information in 
Medicine 1: 8-14, 1967. 

10. Collen, M. F.: Periodic health examinations 

using an automated multitest laboratory. 
JAMA 195: 830-833, 1966. 

11. Collen, M. F.: The multitest laboratory in 

health care of the future. J. Am. Hosp. Assoc. 
38, 1967. 

12. Collen, M. F. and Linden, C: Screening in a 

group practice prepaid medical care plan. As 
applied to periodic health examinations. J. 
Chron. Dis. October, 1955. 

13. Collen, M. F., Rubin, L., Neyman, J., Dant- 

zig, G. B., Baer, R. M., and Siecelaug, A. B.: 
Automated multiphasic screening and diag- 
nosis. Am. J. Pub. Health 54: 741-750, 1964. 

14. Computers in Medicine: Presented by the 

American College of Physicians at the Uni- 



versity of Wisconsin, Madison, Wisconsin. 
October 7-11, 1968. 

15. Encle, Jr., R. L. and Davis, B. J.: Medical Diag- 

nosis: Present, past and future. I. Present con- 
cepts of the meaning and limitations of medi- 
cal diagnosis. Arch, of Int. Med. 112: 512-519, 
1963. 

16. Encle, Jr., R. L.: Medical diagnosis: Present, 

past and future. II. Philosophical foundations 
and historical development of our concepts of 
health, disease, and diagnosis. Arch. Int. Med. 
112: 520-529, 1963. 

17. Encle, Jr., R. L.: Medical diagnosis; Present, 

past and future. III. Diagnosis in the future, 
including a critique on the use of electronic 
computers as diagnostic aids to the physician. 
Arch. Int. Med. 112: 530-543, 1963. 

18. Symposium: Computers in Medicine. J. Chron. 

Dis. 19: April 1966. 

19. Mayne, J. G., Weksel, W. and Sholtz, P. N.: 

Toward automating the medical history. Mayo 
Clinic Proceedings 43: 1-25, 1968. 

20. Northwestern Mutual Life Insurance Com- 

pany: Electronic pre-underwriting: Coming 
our way soon. Pillar 28: 4-7, 1968. 

21. Singer, R. B.: An analysis of electrocardiographic 

abnormalities in insurance applicants: Bundle 
branch block and related defect. Am. Life 
Convention, 50th Annual Meeting, June, 1962. 

22. Singer, R. B.: Mortality in 966 life insurance 

applicants with bundle branch block or wide 
QRS. The Association of Life Insurance Medi- 
cal Directors, 77th Annual Meeting, October, 
1968. Transactions LII. In press. 

23. Singer, R. B.: The usefulness of mortality and 

survival data in existing medical literature. 
Transactions and Studies of The College of 
Physicians of Philadelphia 36: No. 3; 147- 
157, Jan. 1969. 

24. Slack, W. V., Hicks, G. P., Reed, C. E. and Van 

Cura, L. J.: A computer-based medical history 
system. New Eng. J. Med. 274: 194-198, 1966. 

25. Slack, W. V., Peckham, B. M., Van Cura, L. J. 

and Carr, W. F.: A computer-based physical 
examination system. JAMA 200: 136-140, 1967. 



Metabolic Bone Disease — Facts and Fancy 1 



By ERNEST E. 

IT is impossible to talk very long about 
metabolic bone disease without dis- 
cussing its most common and most 
important component, osteoporosis. It is 
equally patent that any discussion of osteo- 
porosis must concern itself with its three 
etiologic types: osteomalacia, osteolysis and 
osteopenia. It would be well at the outset 
to define these somewhat confusing terms. 

We have all heard the radiologist use 
the term osteoporosis to designate a lo- 
calized area of decreased radiodensity. 
Such usage is confusing, particularly since 
the physiologist and the pathologist fre- 
quently use it to infer a subnormal rate of 
osteoid formation. The term osteoporosis 
should be used as the internist uses it, to 
designate a specific, systemic symptom com- 
plex, the commonest to affect the human 
skeleton, one which usually occurs after 
fifty and which is much more common in 
women. It often manifests itself at the out- 
set by back pain, and loss of vertebral 
substance results in a characteristic radio- 
gram. In more extreme cases, severe 
kyphosis may develop. Osteoporosis is the 
underlying cause of most fractures of the 
hip in the senile, and I venture to say af- 
ter arthritis it is the most important dis- 
abling disease in our senior citizenry. 

The term osteomalacia should be used 
to designate that form of generalized skele- 
tal disease which results from a subnormal 
availability of calcium or of phosphorous 
to provide the salt necessary to mineralize 
the organic matrix of bone, osteoid. In the 
mature skeleton, it is properly called 
osteomalacia. In the growing skeleton, it is 

Thomas Dent Mutter Lecture LXXX, The Col- 
lege of Physicians of Philadelphia, 8 January 1969. 

- Professor of Pathology, Temple University 
School of Medicine, Philadelphia, Pennsylvania 
19140. 



lEGERTER, m.d. 2 

called rickets. If this salt deficiency in 
rickets is due to an inability of the kidneys 
to conserve calcium or to conserve phos- 
phorous, it is called renal rickets. When 
renal rickets is caused by a specific calcium 
ion loss, and this occurs most often when 
both the glomeruli and the tubules are 
affected because of a congenital nephro- 
anomaly such as polycystic kidneys, less 
often to an acquired glomerulonephritis, 
the proper term is renal osteodystrophy. 
When the renal rickets is due to a con- 
genital inability to conserve phosphorous 
by the renal tubules, the term hypophos- 
phatemic rickets is now used. In the recent 
past, this was known as Vitamin D re- 
fractory rickets, and before that the 
Fanconi syndrome. Thus the term renal 
rickets may mean either the calcium defi- 
cient renal osteodystrophy or the phos- 
phate deficient hypophosphatemic rickets. 

Incipient or latent osteomalacia is usu- 
ally called Milkman's syndrome. When 
Milkman published his definitive paper in 
1934 (1), he thought that he was describ- 
ing a new clinico-pathologic entity. Later, 
Fuller Albright (2) recognized this case as 
one of mild and latent osteomalacia. In 
Milkman's syndrome there are one or more 
painful fractures, or, better, pseudofrac- 
tures, without trauma or malalignment. 
Most cases of osteomalacia are the result 
of an occult hypophosphatemic rickets un- 
diagnosed throughout childhood. 

The term osteolysis should be used to 
designate the abnormalities of deossifica- 
tion brought about by an excessive rate in 
absorption of bone. For nearly a half cen- 
tury we believed that it was always pro- 
duced by hyperparathyroidism. Now we 
know that a rare, and therefore unim- 
portant, cause is hypervitaminosis D. Later 
I shall mention the possibility of a third 



7 2 



E. E. AEGERTER 



mechanism of osteolysis, a mechanism that 
is still unproven. 

Finally, I like to use the term osteopenia 
to designate a reduction in bone mass be- 
cause of an inability to elaborate sufficient 
osteoid to support skeletal growth in 
youth or to balance physiologic erosion in 
maturity (3, 4). Its purest form is seen in 
the congenital skeletal dysplasia, osteo- 
genesis imperfecta. Scurvy is a good ex- 
ample of a dietary deficiency type of 
osteopenia. Osteopenia in the adult skele- 
ton is a more obscure expression of a nega- 
tive osteoid balance, often of unknown 
etiology. 

Now we have defined osteoporosis as a 
clinical symptom complex. Osteomalacia is 
a pathologic entity caused by an inability 
to adequately mineralize osteoid; osteoly- 
sis is a pathologic entity, a negative 
osteoid balance due to excessive bone re- 
sorption, and osteopenia a negative osteoid 
balance caused by an inhibition of osteoid 
formation. Now let us turn our attention 
to a review of the pertinent features, 
some fact and some fancy, concerning the 
pathogenesis of these three important 
types of metabolic bone disease. 

In regard to osteomalacia, the facts in 
most instances are more evident than the 
fancy. Most cases of simple childhood 
rickets in this country are caused by a 
dietary deficiency in vitamin D with in- 
adequate absorption of calcium through 
the gut wall. The classical radiograph of 
rickets reveals widening, cupping, spread- 
ing, and spurring in the metaphyseal area. 
These changes are due to the replacement 
of normal rigid bone with irregular masses 
of osteoid and chondroid which are inter- 
mixed without adequate mineralization. 
Failure of calcium absorption due to in- 
testinal diseases, such as steatorrhea, fibro- 
cystic disease of the pancreas, or congenital 
bile duct atresia, is much less common 
though no less real. Rickets, or osteomala- 
cia, depending upon the age of young 
women who place an extraordinary de- 



mand on their calcium stores by multiple 
rapidly repeated pregnancies and pro- 
longed lactation probably occurs, but in 
our experience only in cases in which 
dietary calcium is in jeopardy. 

Renal osteodystrophy has now been ade- 
quately recorded and amply corroborated 
in the recent literature (Fig. 1). In this 
disease, the kidney in chronic uremics 
wastes calcium. The reason for this prof- 
ligate spending of the precious calcium 
ion is not completely understood, but we 
presume it to be an abnormal utilization 
of all available basic cations including 
those of calcium in an attempt to neu- 
tralize the acidosis of a chronic uremia 
which is sufficient to inhibit ammonia 
synthesis but not severe enough to kill the 
patient for a number of years (2). A con- 
tinuous withdrawal of calcium ions from 
the blood stimulates the parathyroids and 
eventually causes secondary hyperpara- 
thyroidism (Fig. 2). The radiogram does 
not differentiate the various types of 
rickets, nor can the microscopist, since the 
sections reveal the same histopathologic 
alterations in renal osteodystrophy as 
those found in ordinary rickets. 

Hypophosphatemic rickets (Fig. 3) is in 
reality a group of diseases based on a 
variety of congenital enzymatic defects, 
probably seated in the kidney tubule lin- 
ing cells. Frazer divided these conditions 
into six subtypes, depending upon the re- 
lated metabolic defect, but in all there is 
an inability to reabsorb phosphates from 
the glomerular filtrate inducing a phos- 
phorous deficiency rickets. Massive doses 
of vitamin D may reverse this process in 
three of these types, hence the name vita- 
min D refractory rickets, though the site of 
action of this drug, whether gut wall or 
renal tubule, is still undetermined. There 
has been much speculation concerning the 
nature of this functional defect. Elongated, 
swan-neck of the proximal convoluted 
tubules, peritubular inflammatory reaction 
with fibrosis and a host of other lesions 




Fic. L Renal osteodystrophy. Kidney disease results in a utilization of calcium ions needed 
for mineralization of osteoid. Failure of rigidification results in dramatic skeletal distortion. 



/ 1 



I I VEGER I I R 




I'K.. 2. The skull in advanced sccondan In pel paialin loidism. I lie "snow-sto! in" granu- 
larity is the same as that found in parathyroid adenoma. 



have been repotted, hut ,u present it is 
widely believed that there is no consistent 
si i iK i ural alteration. 

1 hough il is i ,i] e. we should men! ion ,i 
loin th type ol litkets in this discussion. Il 
is (.died hypophosphatasia or, better, hypo- 
phosphatasenha, because there is ;i dis- 
appearance ol the alkaline phosphatase 
from the blood and from the cells where 
it is normally Eound (Fig. 1). Though phos- 
phorylethanolamine is found in the urine 
.nid though this substance is a substrate 
for alkaline phosphatase in the test tnbe, 
it probably does not enter into the 
pathogenesis of the disease and ma) be 
only a by-product since it is hydrolized at 
a normal rate when injected into the pa- 
tient with hypophosphatasemia. 

A few years ago a new hormone was de- 
scribed by Copp (5). It is now called thyro- 
cahitonin because it appears within and 



may be elaborated In the acinar cells of 
the thyroid (6) rather than the parathyroid 
as originally proposed. Its activity is ap- 
parently concerned with the deposition of 
mineral in osteoid, reducing the serum 
calcium level. Its action appeals to be the 
precise antithesis of parathormone which 
of course mobilizes mineral from bone to 
cause a rise in the serum calcium. Though 
as yet there is no data to support it, it is 
tempting to associate this hormone, or 
rather its lack, with the pathogenesis of 
hypophosphatasemia. 

In Milkman's syndrome, the full-blown 
fracture appears as a broad radiolucent 
line which may cross the entire width of 
the shaft (Fig. 5). In earlier cases the le- 
sion may be just as painful though much 
less obvious. In essence, these lesions rep- 
resent an inability to mineralize, that is, to 
rigidify, the osteoid that is produced to 




Fir,, Hypophosphatemic rickets. This phosphorous deficiency type of rickets produces 
pseudofractures like those of Milkman's sviulrome (see Fig. 5). Both femurs arc involved in this 
patient. 



replace the bone lost In physiologic ero- 
sion. Naturally il is seen best at points oi 
stress where bone turnover is most active. 
In more advanced cases, hank fracture 
occurs and eventualh this lack ol litiidifi- 
cation ma\ produce skeletal damage of 
grotesque proportion. 



The pathogenesis of osteolysis is not as 
clear as that ol most cases of osteomalacia. 
Bui \ve know that parathormone increases 
the number of osteoclasts and that bone 
resorption is accomplished through their 
action (7, 8). We are handicapped in this 
area because as yet we have no practical 



76 



E. E. AEGERTER 




I k.. 1. Hypophosphatemia. In lliis disease, 
mineral sail is available hut I here is failure of 
deposition in osteoid. This phenomenon suggests 
l lit- possibility of failure of thyrocalcitonin activity. 

means of measuring the serum parathor- 
mone level. We do know, however, thai 
parathormone has at least two sites of ac- 
tion. It acts directly upon bone to cause 
deossification mediated by osteoclastic ac- 
tivity. But it also acts upon the kidneys to 
inhibit phosphate reabsorption from the 
glomerular filtrate and thus causes a phos- 
phorous diuresis. Hyperparathyroidism is 
characterized by a high serum calcium 
level and the diagnosis should rarely if ever 
be made in its absence. Diagnosis can fre- 
quently be made by examination of the X- 
ray. The "snow-storm" skull is one of the 
few pathognomonic findings in all radiog- 



raphy. The lacy cortices of the phalanges 
are less trustworthy and the loss of the 
lamina dura is to be regarded as only help- 
ful .11 I JCSt. 

In severe and prolonged hyperparathvj 




Fie. 5. Milkman's syndrome. Wide radiolucent 
bands appear at stress points. These are pseudo- 
fractures, loss of rigid bone and replacement by 
unmineralized osteoid. Since the latter is flexible 
though tough, bending occurs without malalign- 
ment. 



METABOLIC BONE DISEASE 



77 



roidism, the skeleton is weakened at stress 
points to cause dramatic distortion. The 
cortex virtually disappears and the marrow 
is replaced by a fibrosing process, hence, 
the name osteitis fibrosa. Simultaneous 
osteoblastic and osteoclastic activity of this 
degree are seen in no other diffuse skeletal 
disease with the possible exception of 
Paget's. 

Circumscribed areas of massive bone 
destruction, brown tumors, occur in very 
late hyperparathyroidism. It is my belief, 
a belief shared as far as I know, by no 
one of my acquaintance, that these so- 
called brown tumors are caused by intra- 
osseous hemorrhage due to a structural 
weakening because of osteoclastic activity 
and multiple infractions. The presence of 
numerous giant cells, which I believe to 
be osteoclasts, in these so-called tumors 
causes these lesions to be frequently mis- 
diagnosed giant cell tumors of bone (9, 10). 

Nephrocalcinosis occurs because of the 
high calcium and phosphorous ion levels 
in the fluids which perfuse the kidney. 
About five percent of all renal stones are 
said to be caused by this condition. 

Clear cell hyperplasia, or as it is now 
more commonly called, primary parathy- 
roid hyperplasia, was described by Mal- 
lory and Castleman in 1935 (11). Though 
a description of this condition is carried in 
every textbook of pathology and in most of 
internal medicine, it probably does not 
exist as a clinico-pathologic entity. Since 
parathyroid adenoma itself is in no sense 
a neoplasm, but like nodular hyperplasia 
of the thyroid, an endocrine dysplasia, 
primary or clear cell hyperplasia is prob- 
ably nothing more than a more diffuse 
manifestation of what we have always 
called parathyroid adenoma. Primary para- 
thyroid hyperplasia cannot be differen- 
tiated from parathyroid adenoma by the 
clinician and the distinction should not 
be made by the pathologist (12). 

The problems of hyperparathyroidism 
have recently been compounded by the 



recent introduction of some experimental 
data suggesting a second mechanism of 
bone lysis. Reidcnbcrg (13), at Temple, 
produced a negative calcium balance in fat 
women on an acaloric diet. He assumed 
this was due to the acidosis which always 
occurs under these conditions. He pro- 
duced the same effect in a patient who was 
hypoparathyroid, suggesting that the neg- 
ative balance was independent of the 
parathyroid glands. The same results had 
been obtained previously by Lehman and 
co-workers in two hypoparathyroid pa- 
tients. Since the urine calcium was greater 
in amount than could be accounted for on 
the basis of serum loss, it is assumed that 
it came from the skeleton stores by the 
direct action of the acidotic state on bone. 
Thus, after almost exactiy a century of ex- 
perimentation, hypothesis and argument, 
we may be proving the validity of von 
Recklinghausen's original explanation for 
the bone destruction in some of his cases 
of osteitis fibrosa cystica. 

Finally, the pathogenesis of most cases of 
osteopenia is largely conjectural. We can 
only assume that in osteogenesis imperfecta 
there is a congenital enzymatic defect 
with failure of maturation of the osteo- 
blasts, resulting in an inability to produce 
sufficient osteoid to meet the exigencies of 
stress. The precious little bone that is 
formed is of woefully shoddy quality. 

To synthesize an adequate amount of nor- 
mal osteoid, the osteoblast must be pro- 
vided with sufficient amounts of necessary 
building blocks, amino acids and vitamin 
C. It must be subjected to a certain level 
of stress and it can function only in the 
climate of adequate estrogen and androgen 
influence. 

Scurvy is a type of osteopenia. In some 
manner as yet undetermined, ascorbic 
acid is required for the synthesis of the 
three polypeptide chains which are the 
components of the collagen fibers of con- 
nective tissue and osteoid. Because the 
calcium-phosphorous ion product is nor- 



78 



E. E. AEGERTER 



mal in this disease, the osteoid that is 
formed is mineralized, and so by contrast 
it stands out abnormally prominent in 
the radiogram, giving us the white line of 
provisional calcification and the character- 
istic ringed epiphyses. The radiolucent 
scorbutic zone appears because of the sub- 
normal osteoid production and consequent 
lack of opaque mineral. Occasionally one 
will encounter dietary eccentrics who re- 
fuse to eat protein. These people may de- 
velop osteopenia and it is presumed that 
they fail to supply their osteoblasts with 
the required amino acids. 

We have had the opportunity of study- 
ing a very severe case of osteopenia. Poor 
in fortune, but rich in pride, this luckless 
soul attempted to exist on a handful of 
crackers and a cup of tea daily for months. 
Eventually her skeleton, ravaged by the re- 
lentless progression of physiologic erosion 
without the capacity to replace lost bone, 
simply wore out. 

More often those who suffer from the 
malabsorption syndrome or those with se- 
vere and prolonged diarrhea may be de- 
prived of these necessary constituents for 
bone production. 

We need only mention the importance 
of stress in skeletal maintenance. When a 
fractured limb is immobilized in plaster, 
an X-ray demonstrable disuse atrophy oc- 
curs in from six to eight weeks. 

The importance of adequate steroid hor- 
mone influence is dramatically illustrated 
in the patient who has ovarian hypogene- 
sis. Unfortunate women who must undergo 
surgical castration before the menopause 
suffer a similar depletion of their skeletons. 
The cortices are thin; the cancellous bone 
is almost non-existent. 

We have now examined the pathogene- 
sis of osteomalacia, inadequate bone rigidi- 
fication; of osteolysis, abnormal bone de- 
struction; and osteopenia, inadequate bone 
restoration. Now let us consider the 
pathogenesis of the clinical symptom com- 
plex, osteoporosis. 



All human skeletons, regardless of race, 
begin to lose bone mass soon after the age 
of 40 and there is a relentless progression 
of this loss for the remainder of life at the 
average rate of 3 percent per decade in 
males and 8 percent per decade in females. 
The cause for this reduction in bone mass 
is obscure. Frost (14) and Jowsey (15), in- 
dependently and using different tech- 
niques, concluded that this loss is due to a 
speeding up in the rate of bone resorption 
in the latter half of life. This has been 
challenged by Hegsted (16) and others and 
I find their conclusions untenable when 
applied to all cases on the basis of their 
published data. 

Nordin (17) in England, and Lutwak 
in this country, have been the most ardent 
champions of the thesis that a low calcium 
diet is an important cause of osteoporosis. 
This quick and easy explanation has been 
adopted by many others (18, 19, 20, 
21, 22), who, however, have failed to pro- 
vide satisfactory evidence of its truth. Garn 
and associates (23) and Smith (24), using 
the more objective methods of measuring 
metacarpal cortical thickness and relative 
vertebral density in very large groups of 
varying ethnic and geographic distribu- 
tion, have concluded that there is no rela- 
tion between bone loss and calcium intake. 
It is now possible to state unequivocally 
that a dietary deficiency of calcium is not 
an important cause of senile osteoporosis 
in this or any other country. 

It can also be said with equal emphasis 
that stress is a proven factor in osteoid 
elaboration. Cochran and co-workers, 
among others, have provided convincing 
evidence that the mechanism is probably 
through the action of the piezo-electric po- 
tentials. Concerning the importance of hor- 
mones, there is much clinical and therefore 
circumstantial evidence but less factual 
data, though Smith (24) found that rela- 
tive vertebral density and the amount of 
axillary hair are consistently statistically 
related. 



METABOLIC BONE DISEASE 



79 



Posner, and later others, have shown 
that mineral is first deposited in osteoid in 
an amorphous form and the apatite crystal 
grows as the osteoid matures. The earlier 
phase is less stable. If fluoride is made 
available, it will replace a hydroxyl group 
of the amorphous form, stimulating the 
growth of the apatite crystal, thus convert- 
ing an unstable form of osteoid to a stable 
form of bone. Hegsted (16) found that rel- 
atively high levels of fluoride in the water 
supply significantly reduces the incidence 
of osteoporosis. In many clinics through- 
out the country, osteoporotics are treated 
with 20 to 60 milligrams daily of sodium 
fluoride over an extended period up to 2 
to 3 months. About 50% of these patients 
attain symptomatic relief. 

In review, we may now define osteo- 
porosis as a clinical symptom complex re- 
lated to a progressive reduction in bone 
mass caused by osteomalacia, osteolysis or 
osteopenia. It is probable that a combina- 
tion of two or perhaps all three of these 
mechanisms is responsible in most cases. 
Every effort should be made to properly 
evaluate the cause or causes in each case 
since fluoride therapy could hardly be ex- 
pected to benefit those cases in which 
osteopenia is the cause, nor hormones in 
an instance of pure osteolysis. It is prob- 
able that in most cases the exact patho- 
genesis will remain unknown whether one 
uses X-ray studies, chemical analysis or 
biopsy. The biopsy is the least valuable of 
the three methods, notwithstanding sev- 
eral publications to the contrary. We have 
tried all the reported techniques (26, 27) 
and found them equally worthless. Prac- 
tically speaking, in the majority of cases 
one will be forced to treat them by the 
standard method of high protein, high vit- 
amin D and C diet, correction of hormone 
and calcium imbalance, an exercise regi- 
men, and a therapeutic trial with sodium 
fluoride. So treated, the great majority of 



cases, if not all, will eventually attain 
symptomatic relief. 

REFERENCES 

1. Milkman, L.: Am. J. Roentgenol. 32: 622, 1934. 

2. Albright, F., Burnett, C, Parson, W., Reifen- 

stein, E. p and Roos, A.: Medicine 25: 399, 
1946. 

3. Albricht, F.: Ann. Int. Med. 27: 861, 1947. 

4. Nordin, B.: Advances in Metabolic Diseases 1: 

125, 1964. 

5. Copp, D., and Henze, K.: Endocrinology 75: 49, 

1964. 

6. Hirsch, P., Voelkel, E., and Munson, P.: Sci- 

ence 146: 412, 1964. 

7. Johnson, W.: Arch. Path. 10: 197, 1930. 

8. Trueta, J.: Scottish Med. J. 11: 33, 1966. 

9. Jaffe, H., and LiCHTENSTriN, L.: Am. J. Path. 

18: 205, 1942. 

10. Aegerter, E.: Am. J. Path. 23: 283, 1947. 

11. Castelman, B., and Mallory, T.: Am. J. Path. 

11: 1, 1935. 

12. Howard, J.: Transactions and Studies Coll. 

Phys. Phila. 30: 55, 1962. 

13. Reidenberc, M., Sevy, R., and Cucinotta, A.: 

Proceed. Soc. Exp. Biol, and Med. 127: 1, 1969. 

14. Frost, H.: Mathematical Elements of Lamellar 

Bone Remodeling. Charles C Thomas, Spring- 
field, 111., 1964. 
I ">. Gershon- Cohen, J., and Jowsey, J.: Metabolism 
13: 221, 1964. 

16. Hegsted, D.: Federation Proceed. 26: 1747, Nov- 

Dcc. 1967. 

17. Nordin, B.: Proc. Nutr. Soc. 19: 129, 1960. 

18. Kelly, M., Little, K., and Courts, A.: Lancet 

II: 1125, 1959. 

19. Scott, P., McKlsick, V., and McKusick, A.: J. 

Bone and Joint Surg. 45: 125, 1963. 

20. McClendon, J., Jowsey, J., Gershon-Cohen, J., 

and Foster, W.: Nutrition 77: 299, 1962. 

21. Scott, P., Greaves, J., and Scott, M.: Brit. J. 

Nutrition 15: 35, 1961. 

22. Harrison, M., and Fraser, R.: J. Endocrinology 

21: 197, 1960. 

23. Garn, S., Rohmann, C, and Wagner, B.: Federa- 

tion Proceed. 26: 1729, Nov.-Dec. 1967. 

24. Smith, R.: Federation Proceed. 26: 1737, Nov- 

Dec. 1967. 

25. Cochran, G., Pawi.uk, R., and Basett, C: Clin. 

Orthop. 58: 249, 1968. 

26. Beck, J., and Nordin, B.: J. Path, and Bact. 80: 

391, 1960. 

27. WRAV, J., SUGARMAN, E., AND SCHNEIDER, A.: 

J.A.M.A. 183: 118, 1963. 



Memoir of Leighton Francis Appleman 

1874 1968* 



By WARREN S. REESE, m.d. 



IT is my sad duty to record the passing 
of Leighton Francis Appleman, m.d., 
at one time my chief at Wills Eye 
Hospital, and one of the jolliest, best liked, 
most congenial, unusual and faithful of 
the Attending Surgeons. To my knowledge, 
he was the only Attending Surgeon who 
continued to attend and work in the clinic 
regularly after attaining emeritus status. 

He died in Glenside, Pa., on November 
26, 1968, at the age of ninety-four, in a 
house he had remodeled which was orig- 
inally an old mill dating back to about 
1740. 

Dr. Appleman had a varied and interest- 
ing career. He was born on Feburary 19, 
1874, at Glenside, Pa., on the farm of his 
maternal grandfather, David Heist. 

He received his early education at the 
Cheltenham Public School, Friends Cen- 
tral High School, and Princeton Prepara- 
tory School. He entered Princeton Uni- 
versity in 1892, but left in his junior year 
to matriculate at Jefferson Medical Col- 
lege, from which he was graduated in 1897. 
His internship was served at the Reading 
General Hospital, and the following year 
he opened his office in Philadelphia. Ob- 
stetrics was his first interest, but this was 
short lived, and in 1899 he became as- 
sociated with Dr. Hobart A. Hare, Pro- 
fessor of Therapeutics at Jefferson, and 
continued in that department until 1934. 
Dr. Appleman taught pharmacy at Jef- 
ferson. Having been one of his pupils, I 
can attest to his popularity and interest- 
ing manner of teaching. Indeed, I con- 

* Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



sidered him one of the best teachers. I am 
sure that his students will remember 
Basham's Mixture, Donovan's Solution and 
Coxe's Hive Syrup, the latter a "vehicle" 
for Dr. Appleman's favorite Spoonerism: 
"Gentlemen, that is not Hive's Coxe 
Syrup." During this time, he acted as 
Assistant Editor of Progressive Medicine 
and carried on an active practice in oph- 
thalmology which he began in 1899 when 
he was appointed to Dr. Howard F. Han- 
sell's Staff in the Polyclinic, later Graduate 
Hospital. He was also Clinical Assistant 
to Dr. George E. deSchweinitz from 1899 
to 1902, when the latter was Professor of 
Ophthalmology at Jefferson. In 1914, he 
was appointed Associate Professor of Oph- 
thalmology in the University of Pennsyl- 
vania Graduate School and lectured on 
ocular therapeutics. 

Dr. Appleman was made Attending 
Surgeon at Wills Hospital in 1924, serving 
until his retirement in 1939. He was also 
Ophthalmologist to the Burd School, 
Douglas Memorial Hospital, and Consult- 
ing Ophthalmologist to Mercy Hospital. 

He was a member of the Philadelphia 
County Medical Society, the Pennsylvania 
State Medical Society, the American Medi- 
cal Association, the American Ophthalmo- 
logical Society, and a Fellow of The Col- 
lege of Physicians of Philadelphia and the 
American Academy of Ophthalmology and 
Oto-Laryngology. 

He also held membership in the His- 
torical Society of Pennsylvania, the Geo- 
graphic Society, the Fort Washington His- 
torical Society, the Sons of the Revolution, 
the Genealogical Society of Pennsyl- 
vania, the Episcopal Church and the Epis- 
copal Church Club. 



80 



MEMOIR OF LEIGHTON FRANCIS APPLEMAN 



81 



Dr. Appleman was among the first to do 
intracapsular cataract extractions rou- 
tinely at Wills Hospital, and he was one 
oi the few, if not the only man, who 
presented an unusual case in which he 



had made a mistaken diagnosis before the 
august College of Physicians. 

He is survived by a son, Leighton F. 
His wife, Anna Hough Parson, passed 
away on January 21, 1944. 



Memoir of Joseph Howard Cloud 
1872-1968* 

By VICTOR C. VAUGHAN, III, m.d. 



JOSEPH Howard Cloud, a member of 
The College of Physicians of Phila- 
delphia for fifty-eight years, died on 
April 27, 1968, four days before his ninety- 
sixth birthday. 

Dr. Cloud was born in West Philadel- 
phia, in an area then known as Heston- 
ville, and moved with his family to Ard- 
more in 1884. After attending Friends 
Select School, he entered Jefferson Medi- 
cal College and was graduated with the 
Class of 1892. He served a year as assistant 
to Dr. H. M. Neale in Upper Lehigh, 
Pennsylvania, and then spent eight years 
in the anthracite coal region as physician 
for the miners. In 1901, he returned to 
Ardmore as assistant to Drs. Robert H. 
Alison and George Gerhard. Later he es- 
tablished his own practice on West Mont- 
gomery Avenue, where he remained active 
until 1947. 

Dr. Cloud joined the staff of the Bryn 
Mawr Hospital in 1906 and became a 
member of The College of Physicians of 
Philadelphia in 1910. He served in France 
with Base Hospital #10 of the Pennsyl- 
vania Hospital from 1917 to 1919, holding 
the rank of major. He was a member of the 
Montgomery County Medical Society and 
of the American Medical Association. His 
addresses and medical publications include 
a report of a case of chronic tetanus fol- 
lowed by scarlet fever (1893), a report on 
the mining town and its company doctor 
(date uncertain), discussion of the Rela- 
tion of the Physician to Beneficial Soci- 
eties (1901), a Brief Review of 500 Cases 

* Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



of Labor (1902), an address to the graduat- 
ing class of the School of Nursing of Bryn 
Mawr Hospital (1911), a paper on Con- 
valescence, with Special Reference to the 
Philadelphia Area (1937), and a report on 
Medicine in the Horse and Buggy Days 
(Philadelphia Medicine, November 13, 
1959). Dr. Cloud regularly made his medi- 
cal rounds on horseback in mining country 
and with horse and buggy in the early 
years of his practice in Ardmore. 

Dr. Cloud was a fifth generation de- 
scendant of Jeremiah Cloud (who came to 
America with William Penn in 1682) in a 
line which included at least two other 
physicians. His grandfather, Joseph Cloud, 
was a Revolutionary War soldier. He him- 
self was a birthright member of the Re- 
ligious Society of Friends. 

In 1914, Dr. Cloud married Elisabeth 
Valentine Perot. Besides Mrs. Cloud, sur- 
vivors include Mrs. Victor C. Vaughan, 
III, of Germantown, Laurence P. Cloud, 
m.d., of Boston, Massachusetts, and three 
grandchildren. 

Dr. Cloud's inquiring quality was a 
hallmark of a career which spanned the 
history of modern medicine. (He was thir- 
teen years old when Louis Pasteur im- 
munized Joseph Meister against rabies.) 
His eagerness and enthusiasm for new in- 
formation and ideas in medicine and other 
sciences kept him in attendance at medical 
gatherings and visiting the observatory at 
Bryn Mawr College well after his retire- 
ment. He will be remembered as a gentle 
and devoted physician and friend, with 
aspects of thoughtfulness, simplicity and 
serenity that gave rich meaning to his 
Quaker ancestry. 



82 



Memoir of John Arthur Daugherty 
1902-1968* 

By EDWARD C. RAFFENSPERGER, m.d. 



JOHN Arthur Daugherty, m.d., was 
born August 12, 1902, at Carlisle, 
Pennsylvania. His early education 
was in Harrisburg. He was graduated from 
the University of Pennsylvania in 1924 and 
from Jefferson Medical College in 1928. 
After internship and residency training at 
the Harrisburg Hospital, he remained 
there as an attending physician until his 
sudden death at his home on August 28, 
1968. 

Besides being Chief of Staff of the Har- 
risburg Hospital just prior to his death, 
he was also a member of many state and 
national professional organizations, includ- 
ing the American Diabetic Association, 
American Heart Association, and the 
American College of Physicians. He was a 
delegate to the Pennsylvania Medical So- 
ciety. He became a member of The College 
of Physicians of Philadelphia in 1955. 

He became a corporate member of the 
Medical Service Association of Pennsyl- 

• Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



vania (Blue Shield) in 1944, elected Presi- 
dent in 1915, and became Chairman of 
the Board in 1966. During this time he 
served one term as President of the Na- 
tional Association of Blue Shield Plans. 
At the time of his death he was a Director 
and Chairman of the By-Laws Committee. 

His greatest service to organized medi- 
cine has been in the area of prepay medi- 
cal care. He was largely responsible for the 
steady growth of the Blue Shield Plans, 
both state and national. It was through 
his efforts that Blue Shield grew from a 
"paper" organization to the largest Blue 
Shield plan in the United States, serving 
all of Pennsylvania. 

He was a tireless worker and a good 
physician. He will be missed by his many 
patients and friends as well as by his as- 
sociates at Blue Shield. 

Dr. Daugherty is survived by his wife 
and three sons, Richard M., Ronald M. 
and the Reverend Robert M., and also by 
a sister, Mrs. Clarence E. Ulrich, and a 
brother, J. Dwight Daugherty, ph.d., of 
Kutztown, Pennsylvania. 



83 



Memoir of Matthew S. Ersner 
1890-1968* 



By DAVID MYERS, m.d. 



IT is an honor indeed to write about my 
chief, "Matt" Ersner. I first met him 
while a student in the School of Medi- 
cine of Temple University. This was in my 
junior year, 1929. Dr. Ersner had just been 
appointed Professor of Otology in his 
alma mater. We were introduced to the 
subject of otology, and I was associated 
with him from then until his death. 

Matthew S. Ersner came to this country 
as a child, his family having immigrated 
from Russia. He worked very hard from 
early childhood. He often told me of his 
days as a Western Union messenger boy, 
as well as his many other jobs. 

He had a fine tenor voice and supple- 
mented his income while at school by sing- 
ing in a choir, in the local churches and 
synagogues. 

In 1912, he was graduated from the 
Temple University School of Medicine. 
He then did post-graduate studies in bac- 
teriology and immunology with the late 
Dr. John Kolmer. Through his association, 
he began to do studies in middle ear and 
mastoid infections with the late Dr. George 
M. Coates. This led him into the study 
of otology. 

The early days in our field in the pre- 
antibiotic era were days of horrendous 
complications and heroic surgery because 
of the serious complications that resulted 
from mastoid and sinus infections. "Matt" 
Ersner was superb in his attack on these 
problems. He was bold and thorough. He 
accepted the most serious and urgent prob- 
lems without hesitation, and his technique 
was magnificent. In the days before the 

• Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



introduction of the high speed electric 
drills and cutting burrs and the binaural 
operations microscope, a mastoidectomy 
was a real challenge. The operation was 
done with mallet, chisel and gouges. 
Watching "Matt" at work was like watch- 
ing a fine sculptor; he was the "Michel- 
angelo of Otology." Later he helped pio- 
neer new techniques, such as the Lempert 
fenestration operation, and he encouraged 
work in new fields, such as the field of 
rhinoplasty and the field of endaural, 
per-meatal otologic surgery, following the 
development of Samuel Rosen. 

He did a great amount of research work 
and pioneered many new procedures. His 
list of publications was tremendous and 
covered a wide variety of subjects. His 
writing and study were done late at night, 
on weekends and holidays. This often was 
added on to an already tumultuous day 
which started early and ended late. A 
typical day would be marked by an early 
start, a long morning in the office, a quick 
lunch, an afternoon of surgery, rounds, 
lectures and teaching. When the day's 
work in the hospital was completed, nu- 
merous house consultations were made 
(again in pre-antibiotic style), to be fol- 
lowed by a late supper, if he was lucky, 
and then by emergency operations until 
late in the night and early morning. 

He was a wonderful teacher who spent 
a great amount of time in instructing his 
students in all the things he knew. He was 
very generous in allowing young men to 
get started in surgery, and he would stand 
by the operating table patiently while we 
made our first awkward starts. He was an 
exciting lecturer and professor. He gave a 
great deal of himself to students and resi- 



84 



MEMOIR OI MATIIII.W s I.RSM.R 



85 



dents at the Temple University Medical 
Center. He was very active in alumni af- 
fairs and helped build up the Temple 
University School of Medicine in its ear- 
liest days. He was very attached to his 
alma mater and gave generously of him- 
self. His interests in communal activities 
were numerous. He was very charitable, 
served on many committees and was an 
all-around member of the Philadelphia 
community. 

Over the years, he kept close contact 
with all of his ex-residents and friends. 
Many of the young men that he trained 
later became professors in medical schools 
throughout the country. Other men are 
chiefs of service at many hospitals through- 
out the United States. It would be im- 
possible to name the great number of men 
who came under his influence. For many 
years he was Professor and Lecturer at the 
Graduate School of Medicine of the Uni- 



versity of Pennsylvania, and year after 
year he never missed his weekly lectures, 
which he prepared each time as though 
he had never given them before. 

He was a wonderful son, father, husband 
and brother. His family contacts were very 
close and intimate. The Ersner family 
gathered about their big brother. 

I might dwell upon his great suffering, 
when he became ill and required an am- 
putation of his leg, and his fight for re- 
covery and rehabilitation. Even then he 
carried out his office work and care of 
his patients, although he had great dif- 
ficulty getting around on an artificial 
limb. 

I could go on and on about the merits 
of this wonderful man, who made a place 
for himself in American medicine after 
having arrived in this country as a poor 
immigrant boy, who worked his way up to 
the highest rank in our profession. 

May he rest in peace. 



Memoir of Archer P. Crosley, Jr. 
1920-1968* 

By JOHN KAPP CLARK, m.d. 



A RCHER P. Crosley, Jr., m.d., was born 
/-\ in Trenton, New Jersey, on October 
^30, 1920. In 1942, he was graduated 
from Ursinus College cum laude with de- 
partmental honors in biology. In 1945, he 
was graduated from the University of 
Pennsylvania School of Medicine, where 
he was a member of Alpha Omega Alpha, 
and served an internship at the Hospital 
of the University of Pennsylvania. Follow- 
ing military service in World War II 
when he attained the rank of Captain, he 
returned to the Hospital of the University 
of Pennsylvania for a residency in Internal 
Medicine and later joined the Staff of the 
Renal Section of the Department of Medi- 
cine. After a brief tour in the pharma- 
ceutical industry, Dr. Crosley went to the 
University of Wisconsin where he estab- 
lished a unit for the study of the physiol- 
ogy and pharmacology of the human kid- 
ney in health and disease. At Wisconsin, 
Dr. Crosley was successful in developing 
the nitrous oxide blood flow method for 
measurements of the hemodynamics of the 
human kidney in the anuric state. He also 
demonstrated in the normal kidney actual 
values for renal weight in grams by divid- 
ing absolute blood flow values obtained 
by PAH clearances by values obtained by 
nitrous oxide which, of course, gives blood 
flow in terms of volume per unit weight. 

In addition to his independent work, 
he collaborated with many other groups 
in measuring renal function in a variety of 
clinical situations. In the course of his 

* Published at the request of the Council of The 
Council of The College of Physicians of Phila- 
delphia. This memoir also appeared in The Phar- 
macologist, Vol. 11, No. 1, Spring 1969, and is re- 
published with permission. 



interest in the kidney, Dr. Crosley came 
to use known drugs as tools to investigate 
physiologic phenomena, in addition to his 
interest in the properties of new thera- 
peutic agents, and as a result of his drug 
studies, was elected a member of the Amer- 
ican Society for Pharmacology and Ex- 
perimental Therapeutics in 1958. While at 
Wisconsin, Dr. Crosley was also active in 
general affairs of the medical school. He 
was a member of the Executive Committee 
and Chairman of the Committee on Post- 
graduate Medical Education, as well as 
serving as Senior Attending Physician. He 
was certified by the American Board of In- 
ternal Medicine in 1955. 

In 1958, Dr. Crosley's interests in clinical 
pharmacology brought him back to Phila- 
delphia, where he joined the Research and 
Development Division of Smith Kline and 
French Laboratories. At the time of his 
death, he was directing the clinical research 
at Smith Kline and French's clinical 
pharmacology units at Presbyterian-Uni- 
versity of Pennsylvania Medical Center 
and the Pennsylvania Hospital. He was 
also Acting Director of Research at the 
Research Institute of the Presbyterian- 
University of Pennsylvania Medical Cen- 
ter, as well as Chief of the Renal and 
Electrolyte Section and Director of Clinical 
Investigation. He was Assistant Professor 
of Medicine in the School of Medicine of 
the University of Pennsylvania, a consult- 
ant in renal disease to Mercy-Douglass 
Hospital, and medical consultant at Inglis 
House. 

Dr. Crosley was nationally recognized as 
a leader in clinical pharmacology. He 
served as a consultant and member of 



86 



MEMOIR OF ARCHER P. CROSLEY, JR. 



87 



special investigative committees for the 
Food and Drug Administration and the 
Commission on Drug Safety. He was a 
member of the ASPET Commitee on 
Toxic Reaction to Drugs from 1964 to 
1965 and was, at his death, a member of 
the Executive Committee of the Division 
of Clinical Pharmacology and its Educa- 
tional and Professional Affairs Subcom- 
mittee. In addition to the Pharmacology 
Society, Dr. Crosley belonged to many 
other medical and scientific groups. He 
was a Fellow of the American College of 
Physicians. He was a member of the Cen- 
| tral Society for Clinical Research, the 
Central Research Club, the American So- 
ciety for Clinical Investigation, The Col- 
lege of Physicians of Philadelphia, the 
Physiological Society of Philadelphia, the 
John Morgan Society of the University of 
Pennsylvania, and the American Society 
of Nephrology, among others. He was the 
author of more than 60 papers in the 



general topics of renal physiology, clinical 
medicine and clinical pharmacology. 

Throughout his career, Dr. Crosley was 
well liked and respected by his many 
colleagues. It was a great pleasure to work 
with him and try to emulate his cheerful 
persistence in the face of difficulty. No 
chore was too difficult or menial for Dr. 
Crosley to tackle with his characteristic 
vigor. 

In addition, he was a deeply religious 
man. He was an elder of the Neshaminy- 
Warwick Presbyterian Church at Harts- 
ville, Pennsylvania, and while at Wiscon- 
sin was active in the foundation of the 
Covenant Presbyterian Church. He is sur- 
vived by his wife, the former Frances A. 
Davis, and three children, Mary C, 
Barbara A. and Archer P., Ill, and his 
father, Archer P., Sr. Dr. Crosley lived a 
short life but managed to pack a great 
deal of solid achievement into his 47 years. 
All of us who knew him have profited by 
so doing. 



Memoir of Andrew J. Donnelly 
1910-1968* 

By PAUL J. GROTZINGER, m.d. 



ANDREW J. Donnelly, m.d., was born 
J-\ November 26, 1910, in Philadelphia. 

"^He attended Villanova College from 
1929 to 1932 and received his M.D. from 
Temple University School of Medicine in 
1936. Following an internship at St. Agnes 
Hospital from 1936 to 1937, he became 
chief resident at that hospital until 1939. 
Starting in 1940, he was acting Assistant 
Pathologist at the American Oncologic 
Hospital, except for the time spent at the 
Lankenau Hospital, where he finished his 
residency in pathology under the late Dr. 
Stanley P. Reimann. He became Patholo- 
gist to the American Oncologic Hospital in 
1943 and held this position until the time 
of his death. His interest in the study of 
tumors led quite logically into experimen- 
tal work at the Institute for Cancer Re- 
search, which he joined in 1945, becoming 
Chairman of the Division of Pathology in 
1960. In addition, he held an appointment 
as Professor of General Pathology at 
Temple University School of Dentistry. 
He was a Diplomate of the American 

* Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



Board of Pathology, having been certified 
in 1944. He was author or co-author of a 
large number of publications, most of 
which were concerned with cancer re- 
search. He was active in professional so- 
cieties and held the office of president of 
the Pennsylvania Association of Clinical 
Pathologists and of the Philadelphia 
Pathological Society. 

Outside of his professional life, he was 
an avid sports enthusiast and actively par- 
ticipated in tennis and, more recently, in 
trap shooting. He was widely read, having 
a particular interest in dramatic literature 
and in the theater. At one period in his 
life he was active in oil painting. 

He was married to the former Elizabeth 
Moran and is survived by her, their two 
children, Frances and Patricia, a brother, 
Patrick, a Maryknoll missionary priest 
stationed in Taiwan, and two sisters, 
Margaret Donnelly and Sister Marie 
Thomas, s.s.j. 

He died November 7, 1968, of an acute 
myocardial infarction. He was a man who 
took great satisfaction from the practice 
of his chosen profession and from research 
and teaching. 



88 



Memoir of Francis Clark Grant 
1891-1967* 

By ROBERT A. GROFF, m.d. 



With the sudden death of Francis Clark 
Grant, a void occurred in the field of 
neurosurgery and among his associates, 
pupils and friends. Dr. Grant spanned the 

1 period between the pioneers in neuro- 
surgery to the present well-trained neuro- 
surgeons with their sophisticated tech- 
niques. He received his training from the 
masters — Dr. Charles H. Frazier and Dr. 
Harvey Cushing — and succeeded Dr. Fra- 
zier as Professor and Chairman of the 
Department of Neurosurgery of the School 

i of Medicine and Hospital of the University 
of Pennsylvania in 1936. He held this 
position until 1953 when an untimely ac- 
cident fractured his hip and right thumb, 
forcing him to retire three years before the 
statutory age. 

Dr. Grant was born in Philadelphia on 
November 9, 1891, the son of William 
S. Grant, Jr., and Jane Burnham Clark. 
He received his early education in Phila- 
delphia and then entered Groton School 
at the age of 13. Because he was well- 
nourished, his fellow classmates gave him 
the nickname "Chubby," which was 

1 adopted by all his friends. He was gradu- 
ated in 1910 and entered Harvard College 
where he made a host of life-long friends 
and developed into an excellent middle- 
weight boxer. Upon completion of his col- 
lege training, he sailed on a mission boat 
for Dr. Grenfell along the coast of Labora- 
dor. He then entered the School of Medi- 
cine of the University of Pennsylvania and 
was graduated in 1919 among the top men 
of his class. 

• Read before The College of Physicians of Phila- 
delphia, 4 December 1968. Prepared and published 
at the request of the Council of The College of 
Physicians of Philadelphia. 



During his medical school days in 1917, 
Dr. Grant married Anne Lewis. They had 
five children, three of whom are still liv- 
ing: Nancy, Francis, Jr., in the Diplomatic 
Service, and Joseph, who is Chief of Medi- 
cine at the Veterans Administration Hos- 
pital in Vermont. 

Following a two-year internship at the 
Hospital of the University of Pennsyl- 
vania, he became an apprentice to Dr. 
Frazier. In those days, the residency pro- 
gram as it is known today had not been 
established. His talents were quickly recog- 
nized so that by 1928 Dr. Grant was ele- 
vated to the position of Assistant Professor 
of Neurosurgery in both the School of 
Medicine and the Graduate School of 
Medicine. Up to this time, he had spent 
part of a year — 1925 — with Dr. Harvey 
Cushing at the Peter Bent Brigham Hos- 
pital in Boston as a clinical clerk. In 
1935, he was promoted to Professor of 
Clinical Neurosurgery in the Graduate 
School of Medicine and, in 1936, he suc- 
ceeded his chief, Dr. Frazier, as Professor 
and Chairman of the Department of 
Neurosurgery in the School of Medicine. 

Dr. Grant wrote many papers, of which 
some 226 or more have been published. His 
writings are characterized by clarity of 
thought, a crisp, clear style and especially, 
a "to-the-point" evaluation of the problem. 
The paper which best exemplifies this is 
the one entitled, "A Study of the Results 
of Surgical Treatment in 2,326 Consecu- 
tive Patients with Brain Tumors." This is 
an outstanding evaluation of the results of 
surgery in brain tumor patients and repre- 
sents a monumental contribution. He con- 
cluded from this study — 659 of these pa- 



89 



90 



ROBERT A. GROFF 



tients having lived for from 5 to 30 years — 
that in a patient who has a removal-type 
tumor one should "put to work the very 
best and most experienced team the clinic 
can assemble." 

One of Dr. Grant's hobbies was the 
taking of photographs of various lesions of 
the brain and spinal cord. Very early, he 
recognized the effectiveness of color pho- 
tography. As a result, he accumulated, to 
the best of my knowledge, the most out- 
standing collection of color slides of surgi- 
cal lesions of the central nervous system. 
He used these freely in his lectures and his 
apt and concise technique of lecturing 
made him one of the most popular lec- 
turers in the School of Medicine. The 
students knew him as the distinguished 
character of the Corn Cob Pipe. 

The training of men for the practice 
of neurosurgery was a major interest of 
Dr. Grant. When the American Board of 
Neurological Surgery was established in 
1937, he became one of the members. 
In 1952, he became Board Chairman. He, 
therefore, played a leading role in formu- 
lating the training program for residents 
in neurosurgery as it is today. 

During World War II, Dr. Grant gave a 
short course to Army Medical Officers on 
the treatment of brain, spinal cord and 



peripheral nerve injuries, in spite of the 
added work load created by younger neuro- 
surgeons entering the service. Nearly 100 
officers took this course. In addition, dur- 
ing his teaching career, he trained over 
30 physicians for the practice of Neuro- 
surgery. 

Dr. Grant was a member of all the 
major neurological and surgical societies. 
In 1951, he was elected an honorary mem- 
ber of the Italian Neurosurgical Society — 
Societa Italiana di Neuro-chirurgia. He 
was a member in one capacity or another 
of 27 hospitals in this area. 

Dr. Grant died of a coronary thrombosis 
in the University Hospital on November 
20, 1967. Just the day before his death, he 
gave my senior resident a lecture on the 
qualifications of a good neurosurgeon. 

To those of us who were close to Dr. 
Grant, he will always be remembered for 
his inspiring personality, his passionate de- 
sire for truth, his frank, outspoken state- 
ment of facts, his profound desire for per- 
fection of not only surgical technique but 
also patient care, and for his love of teach- 
ing students and training men to become 
better neurosurgeons. 

To me, Dr. Grant was a particular in- 
spiration and I owe much of what I have 
accomplished to him. 



Memoir of William E. Krewson, III 

1908-1968* 

By EDMUND B. SPAETH, m.d. 



WILLIAM E. Krewson, III, m.d., a 
distinguished Philadelphia oph- 
thalmologist, respected by all his 
colleagues and beloved by those who knew 
him intimately, died recently after a second 
massive coronary attack. 

The first attack occurred several years 
. ago, and it was thought that his recovery 
from this was complete and permanent. It 
is difficult to reconcile these coronary at- 
tacks with his gentle disposition, his 
kindly, generous attitude to all his con- 
tacts, and the apparent absence of any 
mental stress or strain, except as surmised 
by a few of his intimate friends. 

Dr. Krewson was the only son of William 
E. Krewson, Jr., and Etta May Shoemaker, 
both long-time residents of Germantown. 
His father was a druggist, much better 
described as a pharmacist, with his phar- 
macy in the Mt. Airy area of German- 
town until his death. Dr. Krewson was 
graduated from Germantown High School 
in Philadelphia in 1926 and went on to 
Wesleyan University in Middletown, Con- 
necticut, from where he was graduated 
with honors in 1930. Following his gradu- 
ation, he was active in alumni activities 
of Wesleyan University for many years, 
especially on behalf of potential scholar- 
ship candidates from the Philadelphia 
area. 

He was graduated from the University 
of Pennsylvania School of Medicine in 
1934 and completed a rotating internship 
in the Allentown General Hospital. It is 
quite proper to say that they turned out a 
very fine physician. It is interesting that 

• Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



at the end of his internship his greatest 
field of inquiry was obstetrics and gyne- 
cology. 

Between the time he completed his in- 
ternship and his start in postgraduate 
medical study, he became interested in 
ophthalmology. In retrospect, it seems that 
tli is was probably the result of the long- 
time friendship which existed between 
Dr. Luther C. Peter and his father. In 
1935, he took the Basic Science Course in 
Ophthalmology at the then Graduate 
School of Medicine of the University of 
Pennsylvania. The chairman of the De- 
partment of Ophthalmology at that time 
was Dr. William T. Shoemaker, who also 
shared in the formation of Dr. Krewson's 
decision to enter ophthalmology. 

Following his completion of the basic 
science course and his qualification for a 
Master of Medical Science degree in Oph- 
thalmology, he entered private practice 
with Dr. Luther C. Peter and continued in 
association with him until Dr. Peter's 
death. Following that, Dr. Krewson con- 
tinued in the private practice of oph- 
thalmology, taking over the practice of 
Dr. Luther C. Peter. 

Dr. Krewson continued actively in post- 
graduate teaching in the Department of 
Ophthalmology in the Graduate School of 
Medicine until his death, reaching the 
rank of Associate Professor. 

Early in his practice, he became most 
interested in oculomotor disturbances and 
soon became a well-known and acknowl- 
edged American authority. His associa- 
tion with the Orthoptic Council of Amer- 
ica was evidence of his excellence in this 
field of ophthalmology. 



91 



92 



EDMUND B. SPAETH 



Also, early in his postgraduate practice 
he joined the clinical service of Dr. Ed- 
mund B. Spaeth at the Wills Eye Hospital, 
and from there rose through the ranks of 
staff appointments and promotions to 
reach the positions of Attending Surgeon 
and Chief of Ocular Motility at the Wills 
Eye Hospital, positions he held at the 
time of his death. 

His contributions to the literature of 
ophthalmology and ophthalmic motility 
were all beautifully written and well re- 
ceived. He was meticulous in his study of 
his cases and always willing to present 



and discuss these with the residents, with 
his associates and with referring oph- 
thalmologists. By his death, Philadelphia 
ophthalmology and American ophthalmol- 
ogy lost a dedicated, mature ophthalmolo- 
gist, and the Wills Eye Hospital lost a 
staff member of outstanding stature. His 
wife, the former Mary Britz, is his only 
survivor. 

The writer lost a dear friend and an 
esteemed associate from the time that he 
was a student in the Graduate School of 
Medicine until his demise. He was, in 
every sense of the word, a gentleman. 



Memoir of William Harvey Perkins 
1894-1967* 

By THADDEUS L. MONTGOMERY, m.d. 



WILLIAM Harvey — the name sa- 
vors of medical tradition. We re- 
call the English anatomist, born 
at Folkstone, England, April 1, 1578, 
graduate of Cambridge, student of medi- 
cine under Fabricus, Casserius and Gali- 
leo; author, scholar, discoverer of the 
circulation of the blood. 

1 have sought to trace a connection be- 
tween the names of these two medical 
scholars, so highly regarded in their re- 
spective generations, but there appears to 
be none. Harvey was the mother's family 
name, and William, of course, a common 
title. However, someone inadvertently 
hung above our William Harvey's cradle a 
star, which he gazed upon, and under the 
effulgence of which his career evolved 
and expanded and in a modest way ap- 
proached that of his famous progenitor. 

William Harvey Perkins was born in 
Germantown, Pennsylvania, on October 
21, 1894, the son of Penrose Robinson and 
Mary Harvey Perkins. From an early age 
he manifested interest in science and a 
desire to become a medical missionary. In 
this direction he was undoubtedly nurtured 
by his uncle, E. Newton Harvey, Henry 
Fairfield Osborn Professor of Biology at 
Princeton University, and by his own read- 
ing of the lives of Stanley and Livingstone. 

He was educated at the Germantown 
elementary schools and Central High 
School. In 1913, at the age of 19, he en- 
tered the Jefferson Medical College. He 
served an internship at Jefferson Hospital 
and did his stint of military duty in World 

* Read before The College of Physicians of Phila- 
delphia. 4 December 1968. Prepared and published 
at the request of the Council of The College of 
Physicians of Philadelphia. 



War I as First Lieutenant in the Medical 
Corps of the U. S. Army at Base Hospital 
#120 in Tours, France. 

Incidentally, his classmates and friends 
in medical school had made short shrift of 
his surtitle, William Harvey, and labeled 
him "Cy" after a similarly-built, lanky and 
amiable comedian at Keith's Vaudeville 
Theatre on Chestnut Street, who sang 
songs and cracked jokes about "Cy Per- 
kins, the farmerman." The name stuck the 
remainder of Dr. Perkins' life. Thus, the 
mighty became subject to the common 
place. 

On return from France, "Cy" married 
Barbara Isabelle Bond of Germantown, 
and without further delay the two set 
forth together upon a life's work. He se- 
cured in 1918 an appointment as Medical 
Missionary to Siam under the Presbyterian 
Board of Foreign Missions. In the interior 
of Siam for four years, he dispensed health 
education and medical treatment under ex- 
traordinarily difficult conditions. Without 
the companionship of a courageous wife, 
he would never have survived. Mind and 
spirit were always far ahead of a not too 
rugged constitution. The victim of malaria 
and a succession of tropical boils, he was 
finally forced to return to this country to 
recover health. 

The Rockefeller Foundation provided 
a sabbatical leave during which he visited 
schools of public health and spent a year 
in the medical service of Thomas McCrae 
at Jefferson. This experience and the sev- 
eral years in the back country of Siam 
undoubtedly set the stage for his notable 
career in public health and preventive 
medicine. 

In 1926, through a cooperative arrange- 



93 



94 



THADDEUS L. MONTGOMERY 



ment of the Rockefeller Foundation and 
the Government of Siam, he returned to 
Bangkok as Professor of Medicine in the 
Royal Medical School of Chulalangkarana 
University and Physician to the Govern- 
ment. In these positions he served witli 
distinction until the termination of serv- 
ices of all foreign teachers in 1931. At this 
time, the King of Siam conferred upon Dr. 
Perkins the highest honor of his country, 
the Order of the White Elephant. 

In June 1931, Dr. Perkins was appointed 
Instructor in the Department of Medicine 
of Tulane University School of Medicine 
and the next year Professor and Head of 
the newly organized Department of Pre- 
ventive Medicine. From this position he 
resigned in 1941 to accept the Deanship 
of Jefferson Medical College and the 
Chairmanship of the Department of Pre- 
ventive Medicine. 

The return of William Harvey Perkins 
to his alma mater was an important event 
in the history of that institution. The 
morale of the college was low, its aca- 
demic reputation had ebbed and its leader- 
ship was uninspired. The new dean 
brought clear vision of what the institu- 
tion should be, a scholarly approach and 
inspiring leadership. 

His activities were not confined to re- 
vitalization of the Jefferson Medical Col- 
lege but extended to the growing health 
problems of Philadelphia. He is credited 
with the planning of the ten District 
Health Centers of Philadelphia. He 
chaired for many years the Health Divi- 
sion of the Health and Welfare Council of 
Philadelphia. 

Dr. Perkins was active in the affairs of 
The College of Physicians, particularly in 
the Section on Public Health and Pre- 
ventive Medicine. The College honored 
him by establishing the William Harvey 
Perkins Prize for the best essay on Pre- 
ventive Medicine written by a student of 
any one of the five medical schools of 
Philadelphia. 



Dr. Perkins enjoyed writing poetry about 
his children and grandchildren, prose con- 
cerning the incidents of his life in Siam, 
and treatises on subjects of public health 
and preventive medicine. The former re- 
main unpublished, but the latter are well 
recognized articles and texts, including 
Cause and Prevention of Disease (Lea and 
Febiger, Philadelphia, 1938, 748 pp.) and 
Obstetric Medicine (Edited by Fred L. 
Adair and Edward J. Stieglitz, Lea and 
Febiger, Philadelphia, 1934, Chapters X 
and XI). 

His scholarly career and high position 
brought many responsibilities and many 
honors. These included membership in the 
following societies: 
American Medical Association 
American Society of Tropical Medicine 
American Public Health Association 
National Tuberculosis Association (Re- 
gional Director) 
American Red Cross, Home Hygiene 

Division, (Chairman, 1938, to date) 
Orleans Parish Medical Society 
Louisiana State Medical Society (Chair- 
man, Section on Public Health, etc., 
1941) 

New Orleans Academy of Sciences (Sec- 
retary, 1939, to date) 

New Orleans Council of Social Agencies 
(President, 1941) 

New Orleans Mental Hygiene Associa- 
tion (President) 

Louisiana Society for Mental Hygiene 
(President) 

Social Hygiene Association of New 
Orleans (Vice President) 

Member, Board of Directors, Philadel- 
phia Tuberculosis and Health Associ- 
ation 

Association of Spanish-Speaking Physi- 
cians 

The Medical Club of Philadelphia 
Theta Kappa Psi Medical Fraternity 
Alpha Omega Alpha Honorary Medi- 
cal Fraternity 



MEMOIR OF WILLIAM E. KREWSON, III 



').-) 



Council of Social Agencies 
Community Fund 
Foreign Policy Association 
Fellow, American College of Physicians, 
1942. 

What mainly attracted his friends as 
they grew older with him were his in- 
dividual attributes. He was a friendly per- 
son; he possessed a scholarly mind; he 
pursued his speciality in medicine with en- 
thusiasm; he led his Faculty of Medicine 
in t he paths they would follow; and he 



took time to encircle his wife, his children 
and his grandchildren with love. 

Failing health forced Dr. Perkins to 
resign the arduous duties of Dean in 
November 1950 and of Professor of Pre- 
ventive Medicine in 1959. He died on 
October 22, 1967. 

The Scripture says, "Blessed are the 
meek, for they shall irdierit the earth." 

I should like to add, "Blessed are the 
intelligent, for they may some time prevail 
on earth." 



Memoir of William Whitaker 
1880- 1968* 

By FREDERIC C. SHARPLESS, m.d. 



IT is a pleasure to pay tribute to a 
doctor who left a reputation of un- 
usual medical ability and of compas- 
sionate service to his patients and yet was 
too modest to advertise his good works. 
His self-effacement was proverbial. 

William Whitaker, m.d., was born in 
Philadelphia on August 7, 1880. His fore- 
bears had emigrated from England to this 
country in 1814 and his father was the 
founder of a cotton mill nearby. His son 
was graduated from the University of 
Pennsylvania School of Medicine in 1903, 
being one of the youngest in his class. He 
felt that he owed more to Dr. D. J. Mc- 
Carthy, his quiz master, than to any of 
the regular members of the faculty. Like 
his classmate, Walter George Baird, he 
developed tuberculosis at the medical 
school, but, unlike Baird, he recovered 
with the loss of eight years' work. When 
able to resume work in 1914, he opened 
an office at 5448 Germantown Avenue and 
lived the life of a general practitioner or 
family doctor for about forty years. He 
was associated at first with the revered Dr. 
Howard Fussell at St. Mary's Hospital 
and later with the Episcopal Hospital. 
Here he met a life-long friend, Dr. A. P. 
C. Ashhurst. 

In 1910, he was married, and Mrs. 
Elizabeth B. Whitaker still survives. There 
are no children and Mrs. Whitaker, charm- 
ing and intelligent, devoted her time to 
furthering her husband's success. He de- 
veloped no specialty; he treated rich and 
poor alike, all of whom held great affection 
for him as a skillful doctor and warm 

* Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



friend. His modesty prevented any medi- 
cal writing for publication. His wife says 
that he was far more interested in cure 
than in finance. 

In 1917, the crowning period of his 
career came with the World War I. 
Through the influence of Dr. Ashhurst, 
he obtained enlistment in Pennsylvania 
Base Hospital #10 with the rank of first 
lieutenant. Here he served in the surgical 
section for twenty months and in the British 
General Hospital #16 until his discharge 
at Camp Dix on April 22, 1919, with the 
rank of captain. He had valued very highly 
his association in France with Charles F. 
Mitchell, surgeon (later his surgical consult- 
ant in Germantown), his room-mates, Frank 
Knowles, dermatologist, and the beloved 
Howard Cloud, practitioner in Ardmore, 
now deceased. Also there were James R. 
Cameron, dental surgeon, and many other 
members of Base Hospital #10 staff. His 
only and probably favorite recreation was 
to go on walks with his old companion in 
arms, Dr. Cloud. 

Dr. George Wilson used to tell us that 
where there is somatic illness there is 
usually mental illness as well. Before the 
advent of the sulphas, all honest doctors 
knew that their presence in the sick room 
did the patient more good than their bad- 
tasting medicine, and I am sure that the 
visits of a man like Dr. Whitaker did not 
become any less welcome with the advent 
of the newer drugs. 

The writer once attended Dr. Whitaker 
professionally after his retirement and, 
after two weeks of contact with him, it was 
easy to explain why such an aura of ex- 
cellence had always surrounded him. Dr. 



96 



MEMOIR OI W ILLIAM WHITAKER 



97 



|olin H. Wolf, surgeon to the German- 
town Hospital, had this to say, and he said 
it with enthusiasm: "Dr. Whitaker was the 
most loved man I have every known. He 
was quiet and gentle, with a keen diag- 



nostic sense, most unassuming and modest. 
No one could have at tended to his work 
more faithfully and with more efficiency 
and kindness. He was worshipped by his 
patients." 



TRANSACTIONS V STUDIKS 

"f ^ 

The College of Physicians of Philadelphia 



Volume 37 
(Fourth Series) 




Number 2 
(October 1969) 



Dr. William Bryant (1730 86): American 
Physician and Antiquary 1 



r,\ I RED B. K( )GI RS, m.d. 2 



A FINE contemporary portrait of Dr. 
Willi. mi Bryant, an 18th-cenlur\ 
tenant ot the historic William 
I urn I louse at Trenton, \. |.. dire< is 
toda) 's \ iewei ba< k to I he remai kable life 
ami limes of its subject. The Chevalier 
Bryant, .is this French-trained physician 
was sometimes called, was a well-educated 
and widely-travelled man who participated 
in tumultuous events during the American 
Revolution. A cultured and wcahln pei- 
son, he combined medical practice with in 
terests in natural science and antiquarian 
lore (1). 

W illiam Bryant was born in New York 
City on 3 January 1730/31, son of Captain 
William Bryant and tleanoi his wife, and 
eight days later was baptized in the First 
Presbyterian Church there. Captain F»i\- 
ant. according to the words on the tomb 
stone his son elected in 1772 in St. Peter's 
Churchyard, Perth Amboy, N. J., "in 55 
voyages, in the Merchant Service between 
the Poi ts of New York and London, ap- 
proved himself a faithful and fortunate 

'Kate Html Mead Lecture in Medical History 
\\. Woman's Medical College of Pennsylvania and 
Section on Medical History, The College of Phy- 
sicians of Philadelphia, 15 April 1969. 

- I emple University School of Medicine, Phila- 
delphia, Pennsylvania 19140. 



tder." Captain and Mrs. Bryanl 
look pride in then seven children: \l a i \ , 
the oldest, born in I Tl'l. (tossed the ocean 
with her lather and was tutored in London 
l)\ the Rev. Isaac Watts beloie she re- 
turned to many William Peartree Smith, 
who became mayor of Kli/abeth, N. [.; 
Martha, wed to the Rev. Lorenz T. 
Nyberg. a Swedish Lutheran ministei <»l 
Lancaster, Pa., latet died a widow in Hng- 
Land; Rebecca, married Captain Le Cheva- 
lier Deane, an eminent citizen ol Charles- 
ton, S. C: William, studied medicine, as 
did his \ounger biother. Joshua, who 
practiced on the West Indian island ol 
Grenada; Elizabeth, was the wile ol the 
Rev. Benjamin Woodruff, pastoi ol the 
Presbyterian Church ai Westfield, N. J.: 
.mil Ebenezer, the youngest, born in 1736, 
tcad law and practiced in Klizabcth, N. J. 

(2)- 

William Bryanl was graduated B.A. 
from Yale College in 1717: a decade latei 
he received its M.A. degree (3). As Paris 
excelled as a centei foi surgical stud) up 
to the time ol John Hunter, Bryant 
travelled to France to acquire professional 
skill. [Other Americans who studied at 
Paris or Rheims during this period were 
Drs. Thomas Cadwalader (1708-79), 



99 



inn 



FRED B R.OGI l<s 




Fig. I. Portrait of Dr. William Bryant, now hang- 
ing in The William Trent House, Trenton, N. J. 
Attributed to Matthew Pratt (1734-1805), a pupil of 
Benjamin West. Oil on canvas, 24 x 29", circa 1776. 
The original ownci ol iliis portrait was Elias Boudi- 
not, a friend and kinsman of Dr. Bryant. 

Phineas Bond (1717-73), and John Joins 
(1729-91), all of whom became eminent 
practitioners in Philadelphia.] Greal 
French surgeons of this era included 
Henri-Francois Le Dran, famed lit hot- 
omisi. |ean-Louis Petit, inventor of in- 
struments and procedures, and Jean-Joseph 
Sue. surgeon and teacher of surgeons. The 
Academic RoyaJe dc Chirurgie, founded at 
Paris in 1731, was an organization in 
which these men collaborated. 

Dr. Bryant settled for practice in New 
York City. He remained there until 1769, 
when he purchased for £2,800, by deed 
dated 28 October, an estate called Kings- 
bury at Trenton. Built fifty years earlier 
by the town's founder, William Trent, a 
native of Inverness, Scotland, the house 
and "plantation" was situated at Little- 



bow, where the Assunpink Creek entered 
the Delaware River at its tidal falls (4). A 
contiguous properly was owned In Dr. 
Thomas Cadwalader, a Quaker physic ian 
who lived lrom I iiiu -lo t ime at Lamheiion, 
his wile's family seat south of the town. Dr. 
Cadwalader resided at Trenton from 1743 
to 1750 and was its first chief burgess or 
mayor under royal charter in 1745-40. He 
founded the Trenton Library Company by 
a gift of £500 in 1750 — New Jersey's first 
"public" library. Returning thereafter to 
his native <it\ ol Philadelphia, in 1709 he 
was chosen a vice-chancellor of the Ameri- 
(.iii Philosophical Society, an office he 
filled until his death on 14 November 
1779. His body was interred in the Han- 
over Street Friends Meeting burial ground 
in Trenton (5). 

Dr. Bryant and his wile, Mary, went to 
Philadelphia occasionally on business and 
to visit the doctor's niece, Mary, and her 
husband, Dr. Samuel Dufheld (1732-1814). 
Miss Sarah Eve (1750-74), a young lady 
who died while engaged to be married to 
l)i Benjamin Rush, met Mrs. Bryant at 
the Duffields on 2 November 1773 and 
wrote an uncomplimentary impression of 
her in a later-published diary (6). De- 
scribed as arrogant, domineering and 
stingy, Mary Bryant remained childless 
and, by 1779, was losing her eyesight. For 
these reasons, perhaps, the Doctor sought 
affection elsewhere. Charity Murrow of 
Trenton bore him a "natural" son, also 
named William Bryant, who was acknowl- 
edged and generously provided for by his 
father. 

At Dr. Duffields prompting, Bryant 
wrote out his observations on the electrical 
eel which he had made on a short visit to 
Surinam, a Dutch colony on the northeast 
shoulder of South America. Dufheld read 
the report to the American Philosophical 
Society at Philadelphia on 5 February 
1773. As this was a time when electrical 
phenomena were new and fascinating, the 
electrical eel excited a great deal of atten- 



DR WILLIAM HIM \\ I 



I'll 




Fic. 2. The William Trent House, Trenton, as it appears today. I5uilt in 1710 for Chief 
|iisiu c \\ i lli. ii i] I i cm ol New |( 1 sc\ , w ho died then in 1 71! I il u as the houii "I l)i anil \l i s 
William Bryant from 1709-78. Opened to the public as a museum in 1939. 



(ion. Bryani described his tests, which in- 
dicated that the eel's discharges were simi- 
lar to those of common electricity. He 
noied that altei a period ol confinemenl 
(his "extraordinary animal" lost much ol 
its electric strength, but that when pro- 
voked, iis impact revived. Bryant received 
several "\er\ small shocks" lor his curios- 
ity. The report won him election to the 
American Philosophical Society on 21 
Januar) 177 1. I he papei was published in 
1786 .is Communication No. 12 of Volume 
2 ol i he Society's Transactions ("Account 
ol an Electrical Eel, or the Torpedo of 
Surinam, b) William Bryant, Esquire", 
pages 166-169). There is no record that its 
author ever attended a meeting ol the 
Society; the secretary sent him a member- 
ship certificate in January 1786. 



During the War ol Independence, Dr. 
Bryant evidenced Tom sympathies. His 
name appeals as a hall-pay surgeon on 
the rolls of the New Jersey Volunteers, a 
Lo\alis( regiment raised In General Cort- 
landt Skinner in 1776 (7). On 23 January 
1776, the Burlington County Committee of 
Safety, suspecting that Bryant might be 
planning to join the British Army at 
Boston, plated him on parole; later this 
was extended to thirty miles to permit him 
to \isit Princeton, where he had patients, 
and Philadelphia, where he had relatives. 

Shortly before the Battle of Trenton, 
Bryani warned Colonel fohann Gottlieb 
Rail, commander of the Hessian detach- 
ment stationed there, of an impending 
attack l>\ General Washington's army — a 
warning ignored by the overconfident 



102 



I KI D II !<()(,! RS 



mercenary. Gener;il William S. Sitykcr told 
this anecdote in his book. The Battles o) 
Trenton and Princeton, |>iil>l i-.Ii<-< I in 1808 

(8). 

On Monday morning, December 23, at eleven 
o'clock, I .iriiteiKint Ernsl Christian Schwabe ol the 
von Lossberg regiment met mi king Street l>i 
Willi. mi tin. mi, the physician who lived on the 
Kingsbury Farm, and who was seeking Colonel Rail. 
Km k.ill could not in Eound thai morning, and Dr. 
Bryant left Lieutenant Schwabe with 1 1 it- piomise 
that lie would return l.ilci in llic <l;iy. He did mi, 
and then told Colonel Rail thai he had just heard 
from a Negro who had crossed the river that the 
rebels had drawn rations foi sc\eral d.i\s, and were 
about to attack Trenton. "Ihis is all idle (hatter! 
It is old women's talk." imp. it ieul 1\ answered Colo- 
nel Rail. Rut the doctor, who was aliaid ol In 1114 
lobbed and having his house binned took tin mailt 1 
more sei iotish . 

Dr. Bryant's house, iclerred to in lies 
si, in records as the "Doctor Hauss," over- 
looked an important Delaware Ki\ei leitv 
(siic ol todays Pent) Central Railroad 
bridge). A picket patrol was maintained In 
Hessian sentries between the ferry and the 
"Caserne" or militai\ banacks in the town. 
I he doctoi attended soldiers living in 
whai is tod, w called the Old Barracks — a 

stone structure built in I7.">8 to <|ti.iitei 
British Hoops dining the French and In- 
dian War. (Restored as a museum, the Old 
Barracks, located on the state Capitol 
"rounds at I teuton, was opened to the 
publi< in 1917.) 

1 here were tea 1 1 \ two battles of Tren- 
ton the dramatic sin prise of the Hes- 
sians. 2(i December 177b. and the Battle 
of the Assunpink. 2 January 1777. In the 
first battle, at a cost of none killed, Eoui 
wounded, but two ho/en to death, the 
Americans captured over 900 prisoners, 
1200 small arms, 6 brass cannon and i he- 
colors of the Hessian brigade. (The Hes- 
sians lost 35 killed, including their com- 
mander and 60 wounded. Generals Wash- 
ington and Nathanael Greene spoke with 
the mortally-wounded Rail and in re- 
sponse to his request assured him that the 



prisoners would receive kind treatment.) 
In the second battle, following a signili- 

< .iiit delaying action in which British 
troops nuclei General Cornwallis were re- 
pulsed ai the Assunpink Creek, Washing- 
ion left his camp lues burning and altei a 
bold night march scored anothei \ittoiy 
al I'lincelon. The 1 renton-Pi hit eton cam- 
paign marked the turning point ol the W ar 
of Independent e. 

I he- Kingsbury [arm was a part ol eath 
engagement al [renton. Following seizure 
ol the stone- bridge ovci the Assunpink by 
the Americans in the first battle. Colonel 
Daniel Hitchcock's brigade threw up tem- 
porary breastworks on the high ground 
along the south side ol the creek on the 
Doctor's land. I he subsequent British as- 
sault on the strategic bridge was repulsed 
from this vantage point. Though knows 
to be friendly with the Hessians, Dr. 
Bryant was not molested by the patriots! 
His professional value apparent!) over- 
shadowed political differences and he at- 
tended casualties on each side of the con- 
Bi< t. 

Also during the war, Bryant met his 
partner and successor in practice, Dr. 
Nicholas de Belleville (1753-1831). A na- 
tive of Metz, France, trained as a surgeon 
in Paris. Belleville tame to America with 
the Polish Count Casimh Pulaski as medi- 
cal officer to his legion. W hile camped at 
Trenton in 1777. Dr. Belleville met Dr. 
Bryant, who treated him cordially and en- 
couraged him to enter into partnership. 
Following the death of Pulaski in battle, 
Belleville returned to Trenton late in 1778. 
The New Jersey Assembly, in minutes 
dated 7 October 17iS0, appropriated £4, 1 
s., 3 d. to Drs. Bryant and Belleville "foi 
medical attendance on Enoch Anderson, 
taken sick in service, June 1780" (9). Again, 
on 25 October 1787, after Dr. Bryant's 
death, a petition to the Orphans' Court by 
John Langstaff and his wife Charity 
stated: "That the said Charity is the 
mother of a child named William Bryant, 



DR. WILLIAM BRYANT 



103 



to whom Dr. Wm. Bryant left a considera- 
ble legacy; the acting Executor being 
dec'd, they petition that Dr. Nicholas 
Belleville may be appointed Guardian of 
said Child" (10). Dr. Belleville, who served 
as the boy's guardian until September 
1794, remained at Trenton for the rest of 
his life — esteemed as a physician and the 
progenitor, through his daughter, of a re- 
markable line of descendants. 

During Dr. Bryant's residence at Kings- 
bury, the farm yielded a rich variety of In- 
dian artifacts — stone hatchets, chisels, 
pestles, arrowheads, a pot with handles 
shaped like a porringer's, and a cup made 
of asbestos-like material (11). The Unami 
or turtle clan of the Lenni Lenape Indian 
tribe had formerly been centered near the 
falls of the Delaware River. Some of their 
relics Bryant gave to Pierre Eugene du 
Simitiere, another member of the Ameri- 
can Philosophical Society, for the latter's 
museum on Arch Street in Philadelphia. 
The Swiss-born du Simitiere, antiquary, 
naturalist, artist and designer of the Great 
Seal of the United States, recorded a varied 
correspondence with Bryant between 1776 
and 1783 — concerning almanacs, curios of 
nature, and weather observations (12). Du 
Simitiere's collection, opened to the public 
as the American Museum, remained intact 
for only two years (1782-84). Having de- 
voted his life to the assembling of material 
and specimens for a natural and civil 
history of America, it is unfortunate that 
the General Assembly of Pennsylvania, 
after du Simitiere's death in 1784, did not 
deem it expedient to purchase and preserve 

i his collection, refusal of which had been 

J granted it in his will (13). 

Another antiquarian link of Dr. Bryant 
came through his friend and kinsman, 
Elias Boudinot (1740-1821), a prominent 

I New Jerseyman. Boudinot's younger 
brother, Elisha, of Newark, married Bry- 
| ant's niece, Catharine Smith, in 1778. Like 
I William Penn, Quaker founder of Penn- 
sylvania, and other earlier thinkers, Elias 



Boudinot speculated about the origin of 
the American Indians — believing them to 
be possible descendants of the Biblical 
Lost Tribes of Israel. A firm patriot, 
Boudinot served as president of the Con- 
tinental Congress, signed the Peace Treaty 
of 1783 with Britain, and was a friend of 
George Washington, who appointed him 
director of the Philadelphia Mint (14). 

In 1816 Boudinot had published at 
Trenton a book, A Star in the West; or, a 
Humble Attempt to Discover the Long 
Lost Ten Tribes of Israel, Preparatory to 
Their Return to Their Beloved City, 
Jerusalem. As with the guiding star in the 
east of the Christmas story, Boudinot con- 
sidered the North American Indians to 
have been divinely directed to the New 
World. Although his scholarship was in 
the tradition of many speculative writers 
who had preceded him, Boudinot's book 
climaxed the concept of an aboriginal 
Amerindian connection with the ancient 
Israelites. His work offered, among other 
ideas, the theory that certain Hebrew 
words phonetically resembled those of the 
red man's vocabularies. Published twenty 
years after the death of Dr. Bryant, his 
name does not appear in A Star in the 
West. Almost a century later, however, an- 
other physician-naturalist of Trenton, Dr. 
Charles Conrad Abbott (1843-1919), living 
and working close to the Kingsbury farm 
site, uncovered more solid evidence of the 
aboriginal people in the Delaware Valley. 

Dr. Bryant was a man of considerable 
wealth — real and personal property and 
servants. The Pennsylvania Gazette of 28 
December 1772 listed two servants, "Henry 
Keyuts & Baltzar his son, late of Rotter- 
dam," bound by indenture to Dr. Bryant 
at Trenton before Mayor John Gibson of 
Philadelphia (15). In the Doctor's will, 
probated in 1786, he bequeathed "all my 
Negro slaves except the boy William and 
the girl Peggy" to his widow — with the 
charitable proviso that none of them shall 
"be sent off to or sold in the West Indies 



104 



FRED B. ROGERS 



contrary to their own will and consent" 
(16). Again, in The Pennsylvania Gazette 
of 9 March 1774, Bryant advertized for sale 
or lease "a number of building lots in 
Kingsbury, on east and west sides of 
Broad Street and north side of Delaware 
Street, leading to the river, . . . most de- 
lightfully situated, the soil exceeding good 
for gardening, and excellent water may be 
had at a moderate depth" (17). 

In October 1778, Colonel John Cox of 
Burlington, ironmaster at Batsto and a 
Revolutionary soldier, purchased Kings- 
bury Hall and changed the name of the 
brick mansion to "Bloomsbury Court." 
During the residence of Colonel and Mrs. 
Cox and their six daughters, General and 
Mrs. Washington, the Marquis de Lafay- 
ette, the Comte de Rochambeau and other 
notables visited this charming home. Dr. 
Bryant, who moved to smaller quarters in 
Trenton, gradually withdrew from medical 
practice. A separate release by Mrs. Bryant 
on a real estate sale, dated 8 February 
1781, and executed more than three 
months after the deed of her husband, 
hints at a domestic disagreement, if not a 
separation. The Doctor's final recorded 
purchase of property in Trenton was by a 
deed, dated 17 December 1783, conveying 
to him a house and lot on the east side of 
King (now State) Street (18). 

General Cornwallis, the British com- 
mander in chief, surrendered his forces to 
a combined American and French force at 
Yorktown, Virginia, in October 1781. After 
the curtain fell at Yorktown the players 
began to leave. It was two years, however, 
before the lights were put out and the 
theatre emptied by the departure of 
British and Tories from New York City on 
the famous Evacuation Day of 25 Novem- 
ber 1783. Sir Guy Carleton completed the 
evacuation of his red-coated garrison; 
General Washington and his troops 
marched in, and on 4 December, at 
Fraunces Tavern, the American leader 
bade farewell to his dispersing army and 



rode south to spend Christmas at Mount 
Vernon. 

Dr. Bryant, described by Dr. Belleville 
as elderly before age 50, did not choose to 
leave his native land, as had numerous 
other Loyalists. Sometime after 1783 he re- 
turned to the city of his birth, New York. 
His death, "of an apoplexy," on 11 
January 1786, was noted in the First 
Presbyterian Church register — which 55 
years earlier had recorded his baptism. The 
place of burial was not stated, but it was 
probably in the burying ground surround- 
ing the church on Wall Street. Mrs. Bryant 
lived in comfortable circumstances in a 
house on Crown (now Liberty) Street in 
New York City until her death twelve 
years later. 

By his will, dated 28 October 1785, Dr. 
Bryant left most of his property to his 
widow (19). He further devised, "To my 
natural son, William Bryant, by Charity 
Murrow, £600, to be paid him when he 
arrives at the age of 21 years; he to be sup- 
ported by the interest arising from above 
sum; he to be put to a trade and when he 
has learned the same, £150 more to be 
paid him in the setting up and carrying 
on said trade; if my natural son should die, 
£50 of the above sum to be paid to his 
mother." Substantial bequests were made 
to several nieces and nephews. To his 
nephews, Belcher P. Smith and William 
Pitt Smith, the Doctor bequeathed all his 
books. He left £50 to his namesake, Wil- 
liam Bryant Duffield, oldest son of Dr. 
and Mrs. Samuel Duffield. [Dr. William B. 
Duffield (1770-1841), who received an 
M.D. degree from the University of Penn- 
sylvania in 1790, also practiced in Phila- 
delphia during his lifetime.] 

In Mrs. Bryant's will, executed early in 
1797 and proved 26 November 1798, she 
remembered many friends, Negro servants, 
and relatives (20). Among the kinfolk, she 
left £200 to her husband's illegitimate son. 
This gesture suggests that young William's 
ways were winning — and that Mary Bry- 



DR. WILLIAM BRYANT 



105 



ant's disposition had mellowed since that 
day in Philadelphia when she played the 
great lady in front of Sarah Eve. 

REFERENCES 

1. Wickes, Stephen: History of Medicine in New 

Jersey and of its Medical Men, from the 
Settlement of the Province to AD. 1800. M. R. 
Dennis & Co., Newark, N. J., 1879, pp. 142, 
170-171. 

2. Jones, William Northey: The History of St. 

Peter's Church in Perth Amboy, New Jersey, 
the Oldest Congregation of the Church in the 
State of New Jersey, from its Organization in 
1698 to the Year of Our Lord, 1923, and the 
Celebration of the 225th Anniversary of the 
Parish; also a Genealogy of the Families 
Buried in the Churchyard. Patterson Press, 
New York, N. Y., 1925, pp. 222-224. 

3. Dexter, Franklin B.: Yale Biographies and An- 

nals, 2 vols. Henry Holt, New York, N. Y., 
1897, vol. 2, pp. 107-108. 

4. Hall, John: History of the Presbyterian Church 

in Trenton, N. J., from the First Settlement 
of the Town. Ed. 2, MacCrellish & Quigley, 
Trenton, N. J., 1912, p. 143. 

5. A History of Trenton, 1679-1929. Two Hundred 

and Fifty Years of a Notable Town with Links 
in Four Centuries. Published, in Two Vol- 
umes, under the Auspices of the Trenton His- 
torical Society, Princeton University Press, 
Princeton, N. J., 1929, vol. 1, p. 145; vol. 2, 
p. 640. 

6. Sarah Eve's Journal, in: The Pennsylvania Maga- 

zine of History and Biography 5: 201-202, 
1881. 

7. Jones, Edward Alfred: The Loyalists of New 

Jersey; their Memorials, Petitions, Claims, etc. 
from English Records. The New Jersey His- 
torical Society Collections, Newark, N. J., 1927, 
vol. 10, appendix 3, p. 264. 

8. Stryker, William S.: The Battles of Trenton 



and Princeton. Houghton, Mifflin and Com- 
pany, Boston, Mass., 1898, pp. 1 10-1 1 1. 
9. Nelson, William (ed.): New Jersey Biographical 
and Genealogical Notes. From the Volumes of 
the New Jersey Archives, with Additions and 
Supplements. The New Jersey Historical So- 
ciety Collections, Newark, N. J., 1916, vol. 9, 
p. 57. 

10. Hutchinson, Elmer T. (ed.): New Jersey Ar- 

chives, First Series, vol. XXXVII. Calendar of 
New Jersey Wills, Administrations, etc.; vol. 
VIII— 1791-1795. Jersey City, N. J., 1942, pp. 
56-57. 

11. Potts, William J.: Du Simitiere, Artist, An- 

tiquary, and Naturalist, Projector of the first 
American Museum, with some Extracts from 
his Notebook. The Pennsylvania Magazine of 
History and Biography 13: 361-363; 371-372, 
1889. 

12. Huth, Hans: Pierre Eugene du Simitiere and 

the Beginnings of the American Historical Mu- 
seum. The Pennsylvania Magazine of History 
and Biography 69: 315-325, 1945. 

13. Levey, Martin: The First American Museum of 

Natural History. Isis 42: 10-12, April 1951. 

14. Boyd, George A.: Elias Boudinot, Patriot and 

Statesman, 1740-1821. Princeton University 
Press, Princeton, N. J., 1952, p. 254. 

15. The Pennsylvania Magazine of History and Bi- 

ography 33: 488, 1909. 

16. Hutchinson, Elmer T. (ed.): New Jersey Ar- 

chives, First Series, vol. XXXVI. Abstracts of 
Wills, vol. VII— 1786-1790. Trenton, N. J., 
1941, p. 33. 

17. The Pennsylvania Gazette, March 9, 1774, p. 4, 

col. 2. 

18. Nelson (n. 9), p. 58. 

19. The New-York Historical Society Collections, 

New York, N. Y., vol. 14, Abstracts of Wills, 
Liber 40: p. 91. 

20. The New-York Historical Society Collections, 

New York, N. Y., vol. 15, Abstracts of Wills, 
Liber 42: p. 453. 



Thomas Jefferson and the Doctors 1 



By SAMUEL X 

IT gives me great pleasure to address 
this Greek-letter society which has the 
humanitarian motto, "Worthy to 
serve the suffering," and the Hippocratic 
ideals as its goal. It is a special joy for me 
lo return to Charlottesville, where Dr. 
Robley Dunglison, the hero of my earlier 
literary efforts, first established the medi- 
cal school here in 1825 and won the im- 
mediate esteem and affection of the Father 
of the University of Virginia, Thomas 
Jefferson. For this University had been 
established by an Act of the Legislature 
on January 25, 1819. Soon it will cele- 
brate its sesquicentennial birthday. Even 
though the Board of Visitors, during its 
gestational period, had planned only two 
professors, one to include anatomy among 
his courses, on April 7, 1824, the Board 
determined upon eight professors, and 
stipulated that the School of Anatomy and 
Medicine should teach anatomy, surgery, 
the history of the progress and theories of 
medicine, physiology, pathology, materia 
medica and pharmacy. Out of eight years 
of teaching here came Dunglison's monu- 
mental works: his dictionary, his physiol- 
ogy, a syllabus on medical jurisprudence, 
his work on therapeutics, and others. 

When I received the invitation to come 
here, I pondered upon a fitting subject 
for my talk. Several years ago Mr. James 
A. Bear, Jr., Curator of the Thomas Jef- 
ferson Memorial Foundation at Monticello, 
showed me a manuscript, Medical Chro- 
nology of Thomas Jefferson, which he had 
diligently compiled, recording day by day 

1 Annual Lecture in Medical History, Alpha 
Omega Alpha, University of Virginia School of 
Medicine, Charlottesville, Virginia, 4 November 
1968. 

2 7043 Elmwood Avenue, Philadelphia, Pennsyl- 
vania 19142. 



RADBILL, M.i).-' 

and year by year medical events in the life 
of our great President. It occurred to me, 
since one of the objects of the Alpha Omega 
Alpha is to "ennoble the profession of medi- 
cine and advance it in public opinion," that 
by presenting a glimpse of Jefferson's rela- 
tionship with doctors I could in some small 
measure help to achieve this aim. 

It has often been said that Jefferson had 
a lifelong contempt for physicians. In fact 
he once remarked in the presence of Dr. 
Charles D. Everett, private secretary and 
family physician to James Monroe and 
not partial to Jefferson, that whenever he 
saw three physicians together he looked 
up to discover whether there was not a 
turkey buzzard in the neighborhood, im- 
plying, I presume, that a consultation of 
physicians was an omen of death. Yet 
Jefferson counted a great number of doc- 
tors among his most admired friends, as 
much for his belief in the nobility of 
their profession in the service of the suf- 
fering as in his attraction toward many 
of them for their social consciousness and 
scientific achievements. "In my opinion," 
he once wrote regarding the study of 
medicine, "no knowledge can be more 
satisfactory to a man than that of his own 
frame, its parts, their functions and ac- 
tions." 

To a young friend contemplating medi- 
cine as a career, he expressed his opinion 
concerning the practice of medicine in the 
following words: "The followers of Escula- 
pius are also numerous. Yet I remarked 
that wherever one sets himself down in a 
good neighborhood, not pre-occupied, he 
secures to himself its practice, and, if 
prudent, is not long in acquiring whereon 
to retire and live in comfort. The physi- 
cian is happy in the attachment of the 
families in which he practices. All think he 



THOMAS JEFFERSON AND THE DOCTORS 



107 



has saved someone of them, and he finds 
himself everywhere a welcome guest. If, 
to the consciousness of having saved some 
lives, he can add that of having at no 
time, from want of caution, destroyed the 
boon he was called on to save, he will 
enjoy, in age, the happy reflection of not 
having lived in vain." 

That Jefferson was a great skeptic con- 
cerning much of the theory and practice 
of medicine is common knowledge, yet, 
through his opposition to the practice of 
bloodletting and his objections to irra- 
tional theories, promulgated throughout the 
history of medicine, which could not be 
scientifically proved or withstand the test 
of time, he did help to moderate medical 
. practice and direct medical research into 
more logical and effective channels. Re- 
garding false speculations, he once wrote 
from Paris in 1788 to James Madison that 
"it is always better to have no ideas, than 
false ones; to believe nothing, than to be- 
lieve what is wrong." 

Bloodletting 

It is hard to say just when Jefferson 
developed his opposition to venesection. 
People had faith in bleeding. They had 
I themselves bled when they were well to 
keep themselves well. This was an ancient 
purification practice analogous in the 
primitive mind to menstruation as a form 
of periodic purification. Many physicians 
argued against the practice through the 
ages, but others pushed its use to great 
extremes. It was done by the barber and 
at the public baths, as often as a man took 
a bath. Sydenham, the medical idol of all 
good Englishmen of the eighteenth cen- 
tury, in almost every disease started treat- 
ment by opening a vein. But Pierre Louis 
dealt the death blow to bleeding in 1835 
when by means of medical statistics he 
proved it worthless in pneumonia. 

Long before Louis, however, Thomas 
Jefferson did not permit it to be done in 
l his family. His contracts with the over- 



seers of his estate specified that an over- 
seer was never to bleed a slave. He had 
read LeSage, Smollett, Sterne, Fielding 
and Moliere: all ridiculed the medical 
practice of their time, and he must have 
been influenced by their attitude toward 
bloodletting. From Paris in 1786, Jeffer- 
son wrote to Dr. James Currie: "Medical 
science was demolished by the blows of 
Moliere." Certainly the satires of LeSage 
and Moliere cooled the passion of the 
populace for venesection, but medical 
theorists fortified the practice by many in- 
genious arguments and a leading British 
medical journal, founded shortly before 
Thomas Jefferson died, is still called The 
Lancet. After Louis' persuasive calcula- 
tions, however, this magic wand lost its 
healing power and within a decade or 
two bloodletting was pretty well discarded, 
although I must confess I was still taught 
that it might occasionally prove useful. 

Healing Powers of Nature and 
Medical Theories 

Jefferson, reading Sterne with his wife 
as he nursed her in 1782 during her last 
illness, apparently was impressed when the 
author of Tristram Shandy declared that 
"the physicians here are the errantest 
charlatans in Europe, or the most ignor- 
ant of pretending fools. I withdrew what 
was left of me out of their hands and rec- 
ommended myself entirely to Dame Na- 
ture." Thenceforth, Jefferson firmly be- 
lieved in the ancient doctrine of the "Vis 
medicatrix naturae," the medical power of 
nature. Thirty years later (1812) he wrote: 
"While surgery is seated in the temple of 
exact sciences, medicine has scarcely en- 
tered its threshold. Her theories have 
passed in such rapid succession as to prove 
the insufficiency of all, and their fatal 
errors are recorded in the necrology of 
man." He also gave vent to his objection 
to medical theories when planning the 
curriculum of this' College. He wrote to 
Dr. Thomas Cooper: "Perhaps I should 



108 



SAMUEL X RADBILL 



concur with you also in excluding the 
theory (not the practice) of medicine. This 
is the Charlatanerie of the body as 
theology is of the mind. For classical learn- 
ing I had ever been a zealous advocate; 
and in this, as in his theory of bleeding 
and mercury, I was ever opposed to my 
friend, Rush, whom I greatly loved, but 
who has done much harm, in the sincerest 
persuasion that he was preserving life and 
happiness to all around him." 

Jefferson was a bookworm from child- 
hood. Naturally curious about how the 
body is built, he purchased Cheselden's 
classic book on osteology in 1764. Although 
he opposed the theorizing to which doctors 
were addicted, as well as bloodletting, he 
did advocate knowledge of basic medical 
sciences and of the history of medicine for 
all educated men and recommended the 
study of medicine to prospective students 
of law. Francis Bacon and John Locke, 
whose philosophy he carefully studied, the 
latter a particularly favorite author, had 
strong inclinations toward medicine and 
exerted decided influences upon medical 
philosophy. As a plantation owner, Jef- 
ferson also realized that the health of the 
slaves was economically important. While 
he employed physicians to care for them, 
he was always concerned about the 
medical treatment they received. He wanted 
to know what the doctor was giving him for 
his family and why. When he was suf- 
fering from urinary tract obstruction and 
recurrent diarrhea in the evening of his 
life, that part of his copy of Thomas' 
Practice of Medicine dealing with these 
subjects showed evidence of great wear. 
Many of his medical friends presented him 
with copies of their works. Wistar's Anat- 
omy was in his library; so were Hosack's 
Essays and his Practical System of Nosol- 
ogy, as well as Ewell's Medical Companion 
and his Improvements of the Science of 
Medicine. The American medical journals 
began to appear just before the turn of the 
century and these, too, were in his library. 



Pierre Cabanis 

When he learned that his friend in 
France, Pierre Jean George Cabanis (1757- 
1808), planned a work on the reformation 
of medicine, he expressed his approbation, 
saying, "It needs the hand of a reformer 
and cannot be in better hands than his." 
This book appeared in 1804 and contained 
a history of medicine with attacks on the 
successive systems, theories, hypotheses 
and the like, suggesting research and logic, 
rather than abuse of the doctors by ridicule 
and satire, in order to improve medical 
practice. 

Cabanis taught the history of medicine 
in Paris and was a foreign member of the 
American Philosophical Society. He lived 
at the home of Madame Helvetius, the 
gathering place for savants that included 
the Abbe de la Roche, Turgot, Benjamin 
Franklin as well as Thomas Jefferson, and 
undoubtedly molded some of Jefferson's 
views on medicine. Jefferson, in a letter 
to Thomas Cooper (July 10, 1812), dis- 
cussing psychology and related topics, ex- 
pressed his admiration for Cabanis, when 
he wrote: "A course of Anatomy lays the 
best foundation for understanding these 
subjects . . . and a mature study of the most 
profound of all human compositions, 
Cabanis' Rapports du Physique et du Moral 
de I'homme. This was a book which first 
appeared in 1802. 

Cabanis published a book on the Degree 
of Certainty in Medicine in 1797 which 
was republished in 1802. In New York, 
it was abstracted in English by Dr. Edward 
Miller and more carefully translated later 
by Dr. Rene La Roche in Philadelphia. 
The works of Cabanis, so highly praised 
by Jefferson, and the changes in medical 
philosophy developing in France during 
the first half of the nineteenth century 
helped to moderate medical practice in this 
country. Jacob Bigelow, a private pupil 
of Benjamin Smith Barton, who was the 
friend of Jefferson, in his writings exerted 



THOMAS JEFFERSON AND THE DOCTORS 



109 



a marked impact on the medical profes- 
sion of this country by adapting the 
views of Cabanis to the American scene. 
Appearing first in 1885, his essay on 
"Self-limited Disease" was incorporated in 
1851 into a book entitled Nature in Disease 
which he dedicated to Robley Dunglison 
as a token of his satisfaction in knowing 
that Dunglison concurred with him in 
these principles. In like manner, Elisha 
Bartlett (dubbed "The Rhode Island 
Philosopher" by William Osier) published 
An Inquiry into the Degree of Certainty 
in Medicine and into the Nature and Ex- 
tent of its Power over Disease (1848) in 
which he said he took up the subject 
where Cabanis left off. The image of the 
doctor in Bartlett's opening statement 120 
years ago is as apt now as it was in the 
time of the Roman satires of Martial. "I 
am stating only what everybody knows 
to be true," he wrote, "when I say the 
general confidence which has heretofore 
existed in the science and art of medicine 
... has within the last few years been 
violently shaken and disturbed, and is now 
greatly lessened and impaired. The hold 
which medicine has so long had upon the 
popular mind is loosened; there is wide- 
spread skepticism as to its power of curing 
diseases, and men are to be found every- 
where who deny its pretensions as a sci- 
ence, and reject the benefits and blessings 
which it proffers them as an art." Did he 
have Jefferson in mind when he wrote 
this? 

Government and Medicine 

Jefferson's passion for medical knowl- 
edge went so far as to induce him, when he 
drew up a projected body of laws for the 
Commonwealth of Virginia in 1778, to 
recommend that bodies of those hanged 
for murder be delivered to anatomists for 
dissection. 

He was opposed to government meddling 
I in medical practice, believing that the 
powers of government should extend only 



to such acts as are injurious to others. 
The history of government fallibility in 
medicine and science did not encourage 
him to support the kind of centralized 
supervision we have today. "Reason and 
free inquiry are the only effectual agents 
against error," he said in 1802, while he 
was still in the White House. "Was the 
government to prescribe to us our medi- 
cine and diet, our bodies would be in 
such keeping as our souls are now. Thus 
in France the emetic was once forbidden as 
a medicine, and the potato as an article of 
food. Government is just as infallible, 
too, when it fixes systems in physics. Gal- 
lileo was sent to the Inquisition for affirm- 
ing that the earth was a sphere; the Gov- 
ernment had declared it to be as flat as a 
trencher, and Gallileo was obliged to 
abjure his error. ... It is error alone 
which needs the support of Government. 
Truth can stand by itself." Thus he 
wished to separate science and Government 
as he did Church and State. 

Personal Medical Experiences 

Jefferson's skepticism toward doctors 
and medical practice must have been 
aroused by the shocks of many unfortunate 
medical experiences. His father died when 
he was still at a very impressionable age. 
Whatever the anguish and resentment of 
the young adolescent at this time, however, 
it was certainly not directed at the attend- 
ing physician, Dr. Thomas Walker, who 
was a friend of the family, a highly re- 
spected citizen in Albemarle, related to 
George Washington, and after the death 
of the elder Jefferson, legal guardian to 
Thomas Jefferson until he became of age 
in 1764. 

In the autumn of 1765, Thomas Jef- 
ferson suffered another severe emotional 
shock in the death of his favorite sister, 
Jane, who was three years older than he. 
Jefferson grieved for her all the rest of his 
life. "Longe, Longeque Valeto," he wrote 
in her epitaph. She had mothered him 



110 



SAMUEL X RADBILL 



and was a close companion of his youth, 
for he had been deprived of maternal af- 
fection. 

In 1773 Dabney Carr died at Charlottes- 
ville at the age of thirty from a bilious 
fever. He had been one of Jefferson's 
most intimate friends, his bosom com- 
panion in their studies and had married 
a sister of Thomas Jefferson. The two 
friends now lie in graves not two yards 
apart. 

Carr's death caused a serious mental 
disturbance in his wife, Jefferson's sister 
Martha, herself ill from a recent confine- 
ment. Six fatherless children, along with 
Jefferson's widowed sister, were taken into 
Jefferson's home and raised as his own. The 
death of one of them, Peter, a favorite of 
Jefferson's, not long after was another blow 
to Jefferson. 

But his greatest grief came in 1782 when 
his wife died. He was desolate. Taking 
turns with his sister and his sister-in-law, 
he had nursed her tenderly and for four 
months was never out of calling distance. 
Of the six children born to them, only 
the eldest, Martha, survived to adulthood. 

It is small wonder that he had little 
faith in the help the doctors could render 
and stated that the fatal errors of medical 
theories are recorded in the necrology of 
man. Years later he wrote philosophically 
to John Adams about grief: "I have often 
wondered for what good end the sensations 
of grief could be intended. All our other 
passions, within proper bounds, have a 
useful object. And the perfection of the 
moral character ... is a just equilibrium 
of all the passions. I wish the pathologists 
then would tell us what is the use of grief 
in the economy, and of what good it is the 
cause, remote or proximate." 

I do not know who treated Mrs. Jef- 
ferson in her last illness. Mr. Bear's Medi- 
cal Chronology mentions many doctors, 
from which I would assume that many 
were tried and found wanting. The ac- 
count books of Dr. George Gilmer record 



visits to Mrs. Thomas Jefferson for sev- 
eral years after the Jeffersons were mar- 
ried. George Gilmer, Jr., a year older 
than Jefferson, was the son of a physician- 
apothecary of Williamsburg, nephew of 
Dr. Thomas Walker and classmate of 
Thomas Jefferson. After studying under 
his uncle, Gilmer completed his medical 
education in Edinburgh and eventually 
set up in practice in Albemarle. He mar- 
ried his cousin, Dr. Walker's daughter, 
who was as much a patriot as her husband 
and it is said she offered Mr. Jefferson her 
jewels to use in her country's cause. 

Jefferson and Small Pox 
Prevention 

A practical man, Thomas Jefferson was 
unable to tolerate obscure speculations, 
but the value of inoculation to prevent 
small-pox was real to him. In 1766, when 
he was twenty-three, he took the tedious 
journey to Philadelphia to be inoculated 
by Dr. William Shippen. He had been 
referred to Dr. John Morgan by his friend, 
George Gilmer, who had been a fellow 
student of Morgan's in Edinburgh, but 
Morgan just the year before had assumed 
the professorship of medicine in the 
newly opened Medical School at Phila- 
delphia, and since he limited himself to 
the practice of medicine probably referred 
Jefferson to Shippen for inoculation since 
it was a surgical procedure. When Jef- 
ferson called on Morgan he was in- 
structed and entertained by Morgan's col- 
lection of Italian art and by his European 
reminiscences. One student of Jefferson's 
life believes Jefferson owed to John Mor- 
gan "his real initiation into the arts." The 
doctor's instruction and example were as 
fruitful for the young Virginian's growth 
in that field as were Small's in Science, 
Wythe's in law and Fauquier's in music 
and the refinements of worldly society. 
Morgan also owned a collection of na- 
tural curiosities among which were skele- 
tal parts of a mastodon found at Big Bone 



THOMAS JEFFERSON AND THE DOCTORS 



Lick, Ohio, in 1766. These inspired Jef- 
ferson's curiosity, leading him into a long 
chase after the paleontological mysteries 
of the "mammoth." 

When Jefferson was in Philadelphia 
again in 1775 his slave, Bob, was also 
inoculated by Dr. Shippen; and the first 
thing Jefferson did when he had re- 
covered sufficiently from his grief after his 
wife's death in 1782 was to carry oil his 
own three children together with those of 
his sister to an unoccupied house at Ampt- 
hill to be inoculated. He remained with 
them, acted as chief nurse, defending them, 
I suspect, from the meddlesome medical 
care so often insisted upon before and 
after inoculation by the doctors. It was a 
serious operation. Not only could it turn 
out fatally, but it was necessary to isolate 
the patients in order to prevent the spread 
of the small pox. 

When Jefferson in 1800 learned about 
Edward Jenner's success with the much 
milder cow pox vaccination, he immedi- 
ately gave support to its dissemination in 
this country. 

Benjamin Waterhouse 

The story of how the President and Dr. 
Benjamin W ? aterhouse established vaccina- 
tion in the United States has already 
been told, but I would like to say some- 
thing about Dr. Waterhouse. It was natural 
for Waterhouse, a citizen of Massachusetts, 
first to try to enlist the aid of John Adams 
to encourage the use of vaccination, but 
from Adams he received only verbal en- 
couragement. At this time Jefferson was 
anathema to Adams, and to industrial New 
England in general and Harvard University 
in particular. When Waterhouse of Harvard 
turned to Jefferson he knowingly incurred 
the hostile reaction of his own community. 
Years later John Adams mellowed and 
wrote to Benjamin Rush in 1812: "I am glad 
Waterhouse has a son with you. The father 
commands one of the most elegant and 
masterly pens in America. He is a jewel of 



a man and has been most cruelly used be- 
cause he is a friend of the National Govern- 
ment and because he writes better books 
than any of his profession here." 

Jefferson derived great personal gratifi- 
cation from the results of the successful 
dissemination of vaccine throughout the 
United States. In 1801 Dr. John Redman 
Coxe was able to introduce vaccination in 
Philadelphia by successfully vaccinating 
himself and his fourteen-day-old son with 
vaccine virus sent to him by Jefferson, 
thus propagating live vaccine matter for 
subsequent use. At Jefferson's request, Coxe 
sent him live small pox matter from one 
of his small pox patients which Jefferson 
then used to challenge the immunity of a 
previously vaccinated subject. Jefferson 
ever after retained an affection for the 
oft maligned and badgered Waterhouse, 
continuing a correspondence with him. In 
1808, before leaving office as President, he 
wrote happily to Benjamin Rush that he 
had appointed Waterhouse to the Marine 
Hospital Service in accord with the wish 
of Dr. Rush. This appointment stirred up 
some adverse criticism because Water- 
house was such a controversial figure. In 
this respect John Adams once observed to 
Waterhouse: "I know not two characters 
more alike than Rush's and yours." Writ- 
ing to Adams in 1821, Waterhouse said: 
"President Jefferson gave me a medical 
appointment with $1500 per annum 
avowedly for my successful labours in vac- 
cination. When Dr. Eustis and some of 
the doctors of the Army expressed their 
dissatisfaction at it, Mr. Jefferson replied: 
'During our Revolutionary War, we lost 
in Canada, and on our frontiers, ten 
thousand men by small pox; and we should 
probably lose that number or more should 
we have another war, had not Dr. Water- 
house prevented such a calamity by ex- 
pediting by his incessant labors, the prac- 
tice of vaccination full twenty years sooner 
than it otherwise would have been 
adopted. Besides, I consider not merely 



112 



SAMUEL X RADBILI. 



the Army, but the whole people of the 
United States under obligation to him for 
saving an immense number of lives.' " 

In 1824 Waterhouse sent to Jefferson a 
broadside listing the "heads of a course 
of lectures on natural hist ory given an- 
nually since 1788 in the University of 
Cambridge;" and on May 31, 1825, he 
paid his respects to the Father of the 
University of Virginia at Monticello and 
visited the newly opened University. 

Benjamin Rush 

Benjamin Rush was two years younger 
than Thomas Jefferson. He taught at the 
Medical School of the University of 
Pennsylvania from the time of his return 
from Edinburgh in 1769 until his death 
from pneumonia. Active in practice, he saw 
as many as a hundred patients in one 
day during the yellow fever epidemic of 
1793 and was able to write that day that 
not one of them died. An inveterate writer, 
in addition to his lectures and his medical 
inquiries and observations, he covered such 
diverse topics as slavery, alcoholic drinks, 
Indians, duelling, capital punishment, and 
so on. His account of the maple sugar in- 
dustry was the first publication on the 
subject. In his commonplace book under 
date of May 13, 1791, he wrote: "Break- 
fasted this morning with Mr. Jefferson and 
read to him and Mr. Drinker an account 
of the maple tree and sugar, etc. and 
received some useful hints from each of 
them on the subject." The account was 
published in The Transactions of the 
American Philosophical Society in 1791 
in the form of a letter to Jefferson whose 
efforts to grow sugar maples at Monticello 
had proved unsuccessful. Rush praised 
sugar not only for its dietary usefulness 
but as a medicine in fevers, disorders of the 
heart and other parts of the body, and 
mentioned Franklin's penchant for black- 
berry jam (presumably sweetened with 
sugar) to relieve the effects of the stone; 
he rejected the opinion that sugar injures 
the teeth. He observed in his paper that 



"Mr. Jefferson uses no other sugar in his 
family than that which is obtained from 
the sugar maple tree." Perhaps this was 
good politics on behalf of his friend whose 
political strength needed bolstering in New 
England where the maple sugar came from. 

Though Rush was often wrong, he was 
never undecided, for which his students 
as well as his patients adored him. Pa- 
tients and students expect the doctor to 
know, not "to think." Though Jefferson 
disagreed with Rush on medical theories, 
bleeding, purging and other medical mat- 
ters, the two were in much agreement 
otherwise. They had first met in Phila- 
delphia on June 18, 1775 at a dinner given 
to George Washington a few days after 
Washington was appointed Commander-in- 
Chief of the American Armies. 

Rush characterized Jefferson as not less 
distinguished for his political than his 
mathematical and philosophical knowl- 
edge and wrote that "the whole of Mr. 
Jefferson's conversation on all subjects is 
instructive. He is wise without formality 
and maintains a consequence without 
pomp of distance." During the decade that 
Philadelphia was the capital of the Na- 
tion, they were frequently brought to- 
gether especially at the American Philo- 
sophical Society where they were both 
members. A loyal follower of Jefferson in 
politics, Rush's heartfelt letter of congratu- 
lations on his friend becoming Presi- 
dent of the United States was one of the 
finest Jefferson received. Rush's solicitude 
upon learning of Jefferson's illness, one 
time, touched the latter so that he gratified 
Rush with an account of his symptoms 
and was rewarded with an extended letter 
of medical advice drawn exclusively from 
empirical observation in deference to Jef- 
ferson's distrust of medical theories. After 
Rush died, Jefferson returned Rush's let- 
ters to his family, but this one he kept, 
saying he might want to refer to it again 
when he needed it. 

When Rush presented a copy of his Six 
Introductory Lectures to Jefferson in 1801, 



THOMAS JEFFERSON AND THE DOCTORS 



113 



he informed Jefferson that "vaccination, 
as you have happily called it, has taken 
root in our City and will shortly super- 
sede the old mode of inoculation." A year 
later he mentioned his investigations into 
the causes, seats and remedies of madness 
and other diseases of the mind, requesting 
the loan for a week or ten days of a copy 
of Latude's Memoirs from Jefferson's li- 
brary because it contained an account of 
the author's confinement in the Bicetre 
hospital for lunatics in Paris where Pinel 
had first cut the chains from mad patients. 
When the Lewis and Clarke expedition 
was preparing to set out on its explora- 
tory mission, Jefferson sent Lewis to Phila- 
delphia where Rush, at Jefferson's request, 
prepared medical questions for the ex- 
pedition, as well as medical advice for 
the members of the expedition. This copy 
of medical directions is now in the Library 
of Congress. 

In 1805, Rush applied for the post of 
director of the mint but Jefferson had to 
inform him he had already appointed 
Robert Patterson, citing the need for 
special talents in this post and explaining 
to Rush that decisions of this sort "are the 
most painful part of my duty. ... I must 
anatomize the living man as the Surgeon 
does his dead subject, view him as a ma- 
chine and employ him for what he is fit 
for, unblinded by the mist of friendship." 
Rush suggested to President Jefferson 
that he consider the problems of Yellow 
Fever and quarantine laws in a Message 
to Congress which Jefferson did in his 
Fifth Annual Message of December 3rd, 
1805, recommending an inquiry into the 
state quarantine laws. 

Rush devised a tranquilizing chair for 
the treatment of lunatics and one of the 
last of his publications to appear during 
his lifetime was his classic on Diseases of 
the Mind which won for him the title of 
Father of American Psychiatry. 

One of the most satisfying achievements 
for Dr. Rush in his last years was the 
reconciliation he brought about between 



Jefferson and Adams. Adams gave vent to 
his joy at this reconciliation by calling 
Rush "Mr. Conjurer," saying, "the mighty 
defunct potentates of Mount Wollaston 
and Monticello by your sorceries and 
necromancies, are again in being." 

When Rush died in 1813, he was 
mourned by both Adams and Jefferson. 
From Monticello Jefferson wrote to Adams: 
"Another of our friends of seventy-six is 
gone, another of the co-signers of the in- 
dependence of our country; and a better 
man than Rush could not have left us, 
more benevolent, more learned, of finer 
genius, or more honest." 

The Medical Signers of the 
Declaration of 
Independence 

That Rush was a signer of the Declara- 
tion of Independence, a document so dear 
to the heart of Thomas Jefferson, is 
known to everybody; and nearly every- 
body knows that there were other medical 
signers. But hardly anyone knows who they 
were. All were medical or political ac- 
quaintances of Jefferson. Josiah Bartlett 
was the first to approve the Declaration. 
Chief Justice of New Hampshire and 
Governor, he was the founder and first 
president of the New Hampshire Medical 
Society. 

Matthew Thornton was another signer 
from New Hampshire. He practiced medi- 
cine at Londonderry, was surgeon of the 
New Hampshire troops in the Louisville 
expedition of 1745 and, being absent at the 
time of the signing on August 19, 1776, 
has the distinction of being the last to 
affix his signature. 

Lyman Hall, first trained in the minis- 
try, turned to medicine and was a promi- 
nent practitioner of Georgia when he 
went to Philadelphia with Button Gwin- 
nett and signed the Declaration. He, too, 
was Governor of his State. 

George Taylor, a signer from Pennsyl- 
vania, was an Irish Protestant who stud- 
ied medicine under the duress of his 



114 



SAMUEL X RADBILL 



family's desires but ran away from home 
and came to Philadelphia as a redemp- 
tioner, married the boss' widow and rose 
to fame and fortune in the iron business. 

Oliver Wolcott, who, like his father 
and his son, served as Governor of Con- 
necticut, studied medicine with his brother 
and practiced in Litchfield, but the pres- 
sures of public duties forced him to give 
up medical practice. 

The American Philosophical 
Society 

Jefferson was elected President of the 
American Philosophical Society, an organi- 
zation which, like the Royal Society of 
England, included medicine and anatomy 
in its field of interest. Among its members 
at least sixty-five were physicians, known 
at least by name to Jefferson. Many of 
them were absorbed in study of natural 
philosophy, natural history, husbandry 
and other matters that constantly agitated 
the mind of Jefferson. His first contribu- 
tion to the proceedings, in 1779, con- 
cerned health springs, known as the 
Sweet Springs which he mentioned in his 
Notes on Virginia. He served on Com- 
mittees with Benjamin Smith Barton, 
James Hutchinson, Caspar Wistar, Benja- 
min Rush and other doctors, and only 
Benjamin Franklin and Dr. George B. 
Wood served the Society for a longer term 
of years as president. 

ROBLEY DUNGLISON 

Dr. Wilhelm Moll, in a list of Uni- 
versity of Virginia "firsts," has pointed 
out that Dunglison was the first full time 
American Professor of Medicine in this 
country. One of his courses, instigated by 
Jefferson, was entitled "The History of 
the Progress and Theories of Medicine," 
a title distinctly Jeffersonian and again 
calling to mind Cabanis. Dr. William B. 
Bean, a son of this Alma Mater, pointed 



out in this auditorium that Mr. Jefferson's 
influence on American medical education 
affected Dunglison as it did the entire 
medical profession of this country. Your 
own Dr. C. L. Gemmill has also studied 
the many facets of Dunglison's medical 
work. Jefferson was 82 when Dunglison 
first met him, but mentally clear and his 
logic was irresistible. After Jefferson's 
death, Dunglison went on to become one 
of the foremost medical writers and edu- 
cators of his time and exerted a decided 
impact upon physicians and teachers 
throughout the United States. 

His farewell address when he left the 
University of Virginia reflected much of the 
influence of Jefferson upon him as he re- 
called urging his students to avoid being 
wedded to any exclusive sect or system, to 
watch the march of nature and where in 
doubt to give the patient the benefit of 
the doubt rather than risk safety by rash 
treatment. One of the first tasks under- 
taken by Jefferson after the medical school 
began to function was to assemble for 
Dunglison's teaching a collection of ana- 
tomical preparations. These are listed in 
Dr. John M. Dorsey's book, The Jefferson- 
Dunglison Letters. 

Jefferson chose Dunglison for his per- 
sonal physician, saying, "Time and ex- 
perience are needed to make a skilful 
physician, and nature is preferable to an 
unskilful one. I had therefore made up 
my mind to trust to her altogether, until 
your arrival gave me better prospects." The 
University Board of Visitors then promptly 
passed a resolution on March 5, 1825, per- 
mitting "the Professor of Medicine to 
practice physik within the precincts of 
the University." Seven months later they 
broadened this to permit consultation 
practice. In the words of Gemmill and 
Jones, Dunglison, at the University of 
Virginia, was teacher, savant, scholar and 
physician. 



Felix d'Herelle and Bacteriophage Therapy 1 



By S I | l J. I 

ACCOMPANIED by journeyman ral 
L\ killci Gustal Sondelius and armed 
with crates ol bacteriophage am- 
pules, Martin ^rrowsmith, Sinclaii Lewis' 
charming young avatai ol scientific ideal- 
ism, lands on fictitious St. Huberl n< >i 
merely t<> fighl the plague on the island, 
hul to test object ivch tlie therapeutit ef- 
ficacy i>l his cherished phage: "llall to gel 
tlie phage, hall l<> be sternly deprived." II 
his treatmenl is successful under controlled 
conditions, reasons Arrowsmith, his con- 
tribution is noi onl) ephemerally hu- 
mane, bul also permanently valid as 
Science, and thus in the long run gen- 
uinel) humanistic. Bul a tropical country 
in the grip ol disease he finds to be dis- 
tinctly disorganized and "unstatistical;" 
his decisive experiment is not lnll\ 
achieved — he will contribute to the sci- 
entific literature another "suggestive" but 
ambiguous report on "bacteriophage ther- 
apy." 

Io Felix d'Herelle (Figure 1), the Ca- 
nadian-born (1873) co-discoverer of the bac- 
i teriophage, the curative and prophylactic 
abilities of his finding were never ambigu- 
ous 01 doubtful, but certain and powerful. 
His belief in the ( ausal relationship between 
the bacteriophage and recovery from dis- 
ease was not merely a beneficially applicable 
afterthought to the discovery, but as we 
will sec. an inseparable component of his 
new concept ol infectious disease and re- 
covery. 

The system which he formulated had its 

1 Edward Bell Krumbhaar Prize Essay VIII, Sec- 
tion on Medical History. I lie College of Physicians 
of Philadelphia, 1968. 

2 Class of 1971, Temple University School of Medi- 
cine, Philadelphia, Pennsylvania 19140. 



EITZM.W, h a.'-' 

beginning with an observation nude on .1 
sample ol stool noi Erom .1 dysentery pa- 
tient, but, significantly, from .1 convales- 
( oil ol 1 his hac ill. 11 \ disease ( 1 ). 

One day in the course of these experiments (2), 
having mixed .1 quantity ol filtrati obtained origi 

nail) 1 1 the st< >< il ol .1 dysi 1 1 1 1 n convaleso nt , with 

.1 culture ol dysentery bacilli, I placed them in the 
inc u ha I or hoping thus lo ohtain a soi 1 of "ripening," 

.1 more intimate association hetween the two 
organisms. What \\;is my astonishment on the fol- 
lowing da) 1 h nil the culture media pel Ic e 1 1\ c lear. 

Iii Inline years, as d'Herelle isolated and 
investigated bacteriophages ol othei path- 
ogenic bacteria, he would always observe 
dial he did so only from patients recover- 
ing, and nevei Erom those dying; other 
workers would not agree. 

Following the initial reporl (3) which 
d'Herelle published in the 1!M7 Comptes 
Rendus Acadimie des Sciences, he and 
colleagues at the Institut Pasteur in Paris 
pursued the study of experiineni.il and 
therapeutic aspects of "Bacteriophagum 
intestinale," as he termed it, alter be- 
coming convinced the lytic agent was a 
living parasite of bacteria (4). Apparently 
the earliest direct tests of the curative 
powers of dysentery bacteriophage were 
made by d'Herelle and M. Nadal at the 
Hdpital des Enfants Malades: five chil- 
dren were treated orally with a bacterio- 
phage suspension tested Eoi virulence on 
the "Bacillus dysenteriae Shiga" (i.e., now 
Shigella dysenteriae) isolated from the 
patients' sterols. Strikingly, all the young- 
sters recovered and were discharged from 
the hospital! 

Outside of d'Herelle's group in Paris, 
there was little interest in "Bacterio- 
phagum intestinale" until d'Herelle in 
l!)-!l issued his fust ol several monographic 
summaries (5) of his research, both "basic " 



1 11. 



STEVKN J. I'l l I / \l \ \ 




I n. I. Iclix d'Hcic-llc (I87.V10CI). 



.md "applied." Le Bacteriophage: Son 
role dans Vimmunite and its English trans- 
lation w hit h soon appeared contained the 
basi< elements ol d'Herelle's developing 
s\suin ol infectious disease and recovery, 
and — likel) more stimulating to the medi- 
cal community— the reports ol the remark- 
able success enjoyed in the treatment ol 
bacillar) dysentery. In the next loin years, 
no less than six hunched papers concerning 
one 01 .mother aspect ol the bacteriophage 
phenomenom occupied (he pages ol medi- 
cal journals from all parts of the world, a 
<ioodl\ number in those earlv clays of the 
"literature explosion." Jose da Costa Cru/ 
at the Instituto Oswaldo Cruz in Rio de 
Janeiro initiated trials of treatment of 
dysentery with bacteriophage shortly after 
reading d'Herelle's monograph, but could 
obtain no therapeutic: effec t at fust. W ithin 
two years, however, many apparent sue 



cesses had made him a devoted, though 
geographically distant disciple ol the Cana- 
dian bacteriologist: "Here in Rio de 
Janeiro," he reported in 1924, "the me thod 
has been thoroughly tried out, and is today 
the routine method ol treatment." Da 
Costa Cru/ ((i) even noted thai in some 
cases the "rapidity of the recover) has been 
a cause ol aina/enienl ." On the- other 
hand. Wilburl C. Davison, at the Depart- 
meni ol Pediatrics ol Johns Hopkins, 
issued a paper (7) in 1!)22 — displaying 
somewhat deplorable vagaries ol dosage — 
which reported no noticeable eflect ol the 
phage in treating bacillar\ dysentery. 

Other bacterial diseases were succes- 
sively subjected to bacteriophage therapy 
in the earl) I920's: lieckerich and Haude- 
roy tieated t\phoid and E. coli infections 
in France; liruynoghe and Maisin, and 
Gratia staphylococcus lesions in Belgium; 
Baz) in Fiance and M< Kinky in the 
United States — wound infections (8). 
D'Heielle himsell did some preliminar) 
work with plague bacteriophage in Indo- 
China in 1920 and in Egypl in 1925. These 
names are mentioned foi die primac) ol 
theil work: numerous physicians around 
I he world followed them in the I92()'s and 
later in treating disease with bacterio- 
phage, accumulating a bod) ol the most 
contradictory clinical literature conceiva- 
ble. Every paper reporting exciting success 
could be matched b) at least one noting 
dismal lailure. Then in !')-!(> d'Herelle's 
The Bacteriophage and lis Behavior ap- 
peared, and this new and expanded sum- 
mary, presenting most convincingh the 
apparent evidence for the worth of the 
novel therapy, further encouraged various 
workers, who in turn contributed still 
more confusing and conflicting findings. 

The final major expansion of bacterio- 
phage therapy was mainly begun by its 
perfervid advocate; d'Herelle, whose in- 
volvement with tropical medicine even 
pre-dated his bacteriophage work, once 
termed cholera his "favorite malady." 



FELIX D'HERELLE AND BACTERIOPHAGE THERAPY 



117 



Finally, in 1928 d'Herelle, assisted by 
Major Malone of the Indian Medical 
Service and his staff, commenced a series of 
experiments in the villages of the Punjab 
(9). They first studied untreated patients 
to verify that the appearance of virulent 
anti-vibrio phage in the intestine corre- 

1 spondee! with the occurrence of natural 
recovery. Supported by the findings, 
d'Herelle proceeded to treat cholera orally 
with bacteriophage preparations, but his 
theory of bacteriophage' pointed to even 
more profound benefit: "To cure disease 
once it has developed is not without in- 
terest," he later wrote about the cholera 
programs, "but to prevent the disease is 
still more important." So into each of the 
wells of Ghang, Nawar, and other villages 
of the Punjab members of Major Malone's 
staff poured "two ounces of virulent bac- 
teriophage culture (10)." According to 
d'Herelle, this invariably succeeded in 
stopping incipient epidemics. 

What was the "theory" or "system" of 
infectious disease and recovery which 
d'Herelle constructed upon the bacterio- 
phage phenomenon? With the experiences 

1 with cholera in India providing, in the 
discoverer's mind, additional confirmatory 
evidence, d'Herelle published in 1930 his 

1 most definitive (though concise) statement 
of his ideas: The Bacteriophage and its 
Clinical Application (11). In it is summa- 

' rized the author's concept of bacterio- 
phage and disease. 

Firstly, the bacteriophage (now "Proto- 
bios bacteriophage") is a living, sub-cellu- 
lar parasite of bacteria; as all higher forms 
of life are parasitized, so is the micro- 
scopic pathogen. Disease and recovery are 
functions of the dynamic interactions of 
three organisms: the bacteriophage, the 
bacterium, and the infected animal host. 
d'Herelle concludes (12): 

In brief, when bacteria and bacteriophage are 
brought together, one of three things will happen in 
accordance with the conditions present. The bac- 
teriophage may destroy the bacteria; the bacteria 



may resist and destroy the bacteriophage; or, finally, 
an equilibrium may become established between the 
resistance of the bacteria and the virulence of the 
bacteriophage. In this last case, both survive and 
the bacteria contract a chronic disease, that is, a 
symbiosis is established. Such a state of equilibrium 
is, indeed, extremely frequent in nature. 

These three possible outcomes correspond 
in the host animal to recovery from dis- 
ease, death, and chronic disease. Recovery 
must be distinguished from immunity: the 
mechanisms for immunity from disease, 
whatever they may be, are in no way re- 
sponsible for recovery once disease is mani- 
fest. Without doubt, in bacillary dysentery, 
cholera, plague, and presumably all bac- 
terial diseases, bacteriophage is the means 
of recovery; the sub-cellular "protobe" 
must assume a "virulent" form which will 
lead to both lysis of the bacteria and will 
enhance phagocytosis (13). If the suffi- 
ciently virulent form does not emerge, the 
animal dies. Following recovery, the solu- 
ble remnants of the lysed bacteria stimu- 
late the immunity mechanisms. 

An epidemic represents the adaptation 
of a pathogen to a form resistant to the 
phage, but eventually the tinier microbe 
will in turn assume (mutate) a form viru- 
lent to the bacteria and the epidemic ends. 
Bacteriophage may be spread by means 
identical to those capable of disseminating 
pathogens; thus, an epidemic of disease is 
followed by an epidemic of cure! Finally, 
since bacteriophage is the mechanism of 
recovery from infectious disease, "... ther- 
apy with bacteriophage provides the spe- 
cific therapy par excellence and, it might 
be said, the only possible natural specific 
therapy, for it is the exact experimental 
reproduction of the natural process of re- 
covery (14)." 

Such was the role of the bacteriophage 
in biology as viewed by its co-discoverer 
in 1930, a year which saw continuing trial 
of the new therapy. And by 1930 (and 
probably some years earlier) another factor 
was added to what was becoming an in- 



118 



STEVEN J. PEITZMAN 



creasingly controversial story — commercial 
exploitation. 

While it is difficult to ascertain pre- 
cisely when and which firms began pro- 
ducing and promoting bacteriophage prod- 
ucts, at least three major American drug 
companies (15) included such preparations 
in their catalogues in the early 1930's. E. 
R. Squibb &: Sons recommended its 
"Staphylococcus Bacteriophage Squibb Poly- 
valent" for "staphylococcus infections, 
particularly furuncles and carbuncles," 
claiming for it "an almost immediate ef- 
fect in relieving pain." A twenty-cc. vial 
was priced at $3.50. Lilly Research Labora- 
tories advertised "Bacterial Antigens in a 
Water-Soluble Jelly Base . . . for local ap- 
plication in the treatment of certain in- 
fections." "Staphylo-Jel," the catalogue as- 
sured, produces "... a marked diminution 
in the pain and soreness; the necrotic core 
liquefies rapidly and comes out easily; 
healing is prompt and scarring said to be 
less." Lilly explains its peculiar choice of a 
gel base in terms of convenience and effi- 
ciency; it is possible that this novel prepa- 
ration was also seen as more patentable 
than a simple filtrate. Swan-Myers division 
of Abbott Laboratories also marketed bac- 
teriophage preparations for staphlococcus 
and E. coli infections. 

The Anglo-French Drug Company, an 
international corporation, seems to have 
been the major producer of bacteriophage 
products in the early 1930's. Its "Labora- 
toire de Bacteriophage" in Paris was 
founded by d'Herelle, though an advertis- 
ing pamphlet explains the nature of the 
relationship (16). It reads: 

Since no personal profit was sought by Professor 
d'Herelle, and since it was desired that the Labora- 
tory should retain a purely scientific character, Arti- 
cle 13 of the statutes of the Act of Foundation of 
the firm stipulates that the profits of the . . . [Bac- 
teriophage] Laboratory . . . shall be devoted to sci- 
entific research. 

Contrasting with this admirable statement 
is the undeniably mercantile plea several 



pages later: "When Prescribing Bacterio- 
phages Specify Bacteriophage (d'Herelle) 
THE ORIGINAL BACTERIOPHAGE 
Supplied in Boxes of 10 Ampoules of 2 cc." 
Available from Anglo-French were "Bact£- 
Dysenteri- Phage," "Bactd-Pyo- Phage," 
'Bactd-Coli-Phage," "Bacte-Intesti-Phage," 
"Bact£-Staphy-Phage," and "Bactd-Rhino- 
Phage." 

The proliferation of commercial bacte- 
riophage medicines was in part responsible 
for the first reliable evaluation of the 
whole bacteriophage therapy picture — that 
by the American Medical Association 
Council on Pharmacy and Chemistry late 
in 1934. Evidently the opposing voices of 
the claimants for and condemners of the 
heterodox new treatment had already 
several years before this succeeded in ir- 
ritating the ears of many sincere and 
educated physicians. "There is a rapidly 
growing resentment and distrust of the 
whole bacteriophage promotion," wrote an 
A.M.A. editorialist in 1933 (17), "which 
certainly will delay final clinical evalua- 
tion." The influential British journal 
Lancet commented in 1932 that "the re- 
sults obtained [from many trials of bacte- 
riophage therapy] have been so contradic- 
tory as to suggest to the unbiased and 
non-technical observer that once again a 
vaunted remedy is under-going the slow 
and painful process of discredit (18). . . ." 

This unhappiness with the developing 
story of phage therapy suggests that the 
1934 A.M.A. report was timely and wel- 
comed. The Council on Pharmacy and 
Chemistry, which had never "accepted" 
any of the bacteriophage remedies, comis- 
sioned two highly competent microbiolo- 
gists, Monroe D. Eaton and Stanhope 
Bayne-Jones, to review the literature and 
evaluate the status of d'Herelle's treatment. 
Based upon what appears to be very ade- 
quate survey of the journal reports, the 
conclusions they reached were far from 
enthusiastic. The great majority of the 
clinical articles, they suggested, both pro 



FELIX d'HERELLE AND BACTERIOPI I.U.F. THERAPY 



119 



and con, are not reliable, invalidated by 
poor controls or small series of cases. Only 
in the treatment of focal staphylococcus 
disease and possibly bladder infection is 
the evidence at all convincing. Further- 
more, experimental data from investiga- 
tions using "artificial" disease in animals 
indicate that the bacteriophage phenome- 
non occurs only to a small extent or not at 
all in vivo — body fluids are apparently 
strongly inhibitory. Finally, proposed 
Eaton and Bayne-Jones, "The favorable 
results reported may have been due to the 
specific immunizing action of the bacterial 
proteins in the material used and to non- 
specific effects of the broth (19)." 

Though it is difficult to assess the in- 
fluence of this report, it can at least be said 
that the late 1930's saw the beginning of 
the decline of bacteriophage therapy. At 
the First International Congress for Micro- 
biology in 1930, d'Herelle delivered a 
typically forceful presentation of his the- 
ory (20); he did not participate in the 
larger Second Congress in 1936. Bacterio- 
phage preparations remained in drug 
firms' catalogues, but towards the 1940's 
their antigenic rather than bacteriocidal 
aspect was emphasized. And perhaps most 
significantly, the number of journal re- 
ports dealing with bacteriophage therapy 
diminished substantially as 1940 ap- 
proached. 

In 1941, the A.M.A. Council on Phar- 
macy and Chemistry judged that it was 
time to re-evaluate bacteriophage therapy 
and to bring up to date the literature sur- 
vey of 1934. Albert P. Kreuger and E. Jane 
Scribner were called upon to do this task 
and, like their predecessors, appear to have 
done a competent job. Their evaluation 
was actually somewhat more favorable 
than the earlier report, but they empha- 
sized that there had still been no con- 
vincing demonstrations to finally support 
or discredit bacteriophage therapy. 

While the medical community during 
the 1930's and 40's began somewhat to lose 



interest in his therapy, Felix d'Herelle, un- 
ceasingly confident, pursued several new 
and expansive projects. At the invitation 
of the government of the Soviet Union he 
left Yale University (where he had been 
Professor of Protobiology some years) in 
1934 to establish bacteriophage laborator- 
ies in Xiflis, Kiev, and Kharkov (21). But 
in 1936 one of the purges then prevalent 
in Russia somehow resulted in the arrest 
and execution of Eliava, d'Herelle's old 
friend and colleague from the Institut 
Pasteur years; the Canadian bacteriologist 
returned to Paris. Here he prepared the 
final in his series of periodic monographic 
statements of his work and theories, Le 
phenomene de la guerison dans les mal- 
adies infectieuses, which was published in 
1938. Though he continued his study of 
bacteriophage in a small laboratory in 
Paris, he published very little in the last 
decade of his life, and he died in 1949. 

Perhaps the last significant paper con- 
cerned with bacteriophage therapy was a 
third and final evaluative report in 1945 
by the A.M.A. Council on Pharmacy and 
Chemistry — but limited now to treatment 
of bacillary dysentery (22). The conclu- 
sions? The evidence for the effectiveness of 
bacteriophage in the treatment of bacillary 
dysentery — the ailment for which d'Herelle 
had first attempted treatment more than 
twenty-five years before — was as of 1945 
still inconclusive though suggestive: more 
careful studies should certainly be done! 
They never were: sulfonamides and anti- 
biotics served as the final forces in the 
demise of bacteriophage therapy. 

II 

How is it possible that after nearly 
thirty years of clinical trial, much of it re- 
ported in the journal literature, the worth 
of bacteriophage as therapy was neither 
convincingly established nor disproved? 
While it may be simply argued that the 
history of medicine demonstrates the 
reluctance with which valueless remedies 



STEVEN J. PEITZMAN 



120 

die (bloodletting, Homeopathy), the am- 
biguous verdict for bacteriophage therapy 
may be more specifically attributed to the 
peculiar nature of the diseases upon 
which it was tried, the geographical dis- 
tribution of these diseases, and to the im- 
perfect dissemination of the "scientific 
method" in the period between the two 
World Wars. 

If it be recalled that the diseases treated 
with bacteriophage were mainly bacillary 
dysentery, cholera, and focal staphylococ- 
cus lesions, some of the problems in eval- 
uating the treatment may be imagined. 
Bacillary dysentery and staphylococcus 
abscesses are mainly self-limiting diseases 
of low mortality; thus, even a truly valid 
remedy would not be expected to yield 
spectacular, persuasively dramatic effects. 
Dysentery presents certain diagnostic prob- 
lems "in the field," another potential 
source of confusion. Cholera is perhaps 
more readily diagnosed and can certainly 
be lethal if not properly treated, but like 
dysentery and plague occurs in large num- 
bers in tropical areas not conducive to the 
most careful, impartial studies (23) — as 
Martin Arrowsmith harshly learned! 

With these difficulties sympathetically 
appreciated, the failings of the bacterio- 
phage therapists as scientists may be con- 
sidered. As the comtemporary evaluations 
pointed out, most of the reports — pro and 
con — show small numbers of studied cases 
and poor or no controls. Often faulty 
supervision of treatment and other errors 
invalidated the findings. To illustrate, we 
can select several papers which are by no 
means among the worst offenders. Morison 
and Vardon (24) published "A Cholera and 
Dysentery Bacteriophage" in the 1929 In- 
dian Journal of Medical Research. These 
workers discussed twenty-seven cases of 
cholera; of twenty-one not receiving phage, 
sixteen died, but of the six given phage, 
only one died — suggestive, yet the numbers 
are too few. "The first case in which we 



had an opportunity to test the bacterio- 
phage," writes Morison, 

was admitted to the Military Hospital under Captain 
Roscnbloom, I. M.S., with severe vomitting, large fre- 
quent rice-water stools, cramps and collapse. He was 
given intravenous hypertonic saline to which 2 cc. 
of bacteriophage was added and received 2 cc. of 
bacteriophage in water by the mouth every four 
hours. Within 18 hours he had recovered and ap- 
peared so well that a diagnosis of cholera was 
doubted. Cholera vibrios, strain J., were recovered 
from his stool on the first day of the illness. 

This clinician has given the bacteriophage 
by two different routes, in conjunction 
with other treatment (intravenous saline), 
and then it is not entirely certain that the 
case was cholera! 

Also in 1929, Compton reported his 
success with bacteriophage therapy in 
sixty-six cases of bacillary dysentery in 
Alexandria, Egypt (25). He distributed the 
phage with a "circular instructing the 
patient on the use of the phage" and a 
"questionnaire to the doctor" (local prac- 
titioners were intermediates). The sixty-six 
cases turn out to represent those coopera- 
tive sufferers who bothered to return the 
form out of a total of two-hundred treated 
patients. Compton assumed all the others 
were cured, since if the disease had per- 
sisted, they would have returned to their 
doctor! In fairness to Morison, Compton, 
and by implication many others, it must 
be emphasized that those physicians re- 
porting no success were about equally 
guilty of these methodological "errors." 

If this seeming ignorance of the prac- 
tices of the "scientific method" appears 
inconsistent with twentieth century medi- 
cine, the contradiction is partially re- 
solved by merely accepting the fact of 
gradualness. In very general terms, the 
basis for modern quantitative and objec- 
tive medical study was provided in the 
nineteenth century laboratories of such 
men as Bernard, Ludwig, and Loeb; the 
extension of their methods and ideals 
from the realm of "basic sciences" into 



FELIX D'HERELLE AND BACTERIOPHAGE THERAPY 



121 



clinical medicine and therapeutics has 
been the slow and still incomplete task of 
the present century. Often this extension 
depends on nothing more or less than the 
individual physician, in school or if need 
he later, learning the necessary conven- 
tions and the use of statistics — just as 
Martin Arrowsmith had to acquire calcu- 
lus and physical chemistry to satisfy his 
teacher, Max Gottlieb. Unhappily, the 
practitioners who applied bacteriophage 
therapy and reported their results in the 
1920 s and 1930's were on the whole in- 
completely educated in the needed "new" 
practices. Though probably neither un- 
aware of nor hostile to the ideas of con- 
trols and quantitative expression, they did 
not know how to apply them: as a result, 
their conclusions were too often meaning- 
less. And in fact it must be said that the 
spectacular cures of the bacteriophage 
therapists were classic "artifacts" — illu- 
sions of their own unaware creation (26). 

Felix-Hubert d'Herelle, the most zealous 
and unyielding advocate of his own ther- 
apy, emerges as a paradoxical figure. 
Though seen by his colleagues as a me- 
thodical, disciplined bacteriologist, he was 
guilty, not so much of performing invalid 
studies, but of accepting those of others 
perhaps a little too indiscriminately. 
' Furthermore, the reader of his periodic 
monographs — summary statements of his 
work and theory — is struck by an unfailing 
didacticism and oppressive singleminded- 
ness. Fairly typical is his estimation of his 
impact of bacteriophagy in the preface 
(27) to the 1930 version: 

As the last century closed — that period of blissful 
satisfaction — the biologists also had erected a 
splendid structure into the foundations of which 
they had harmoniously interlocked the cellular 
theory of life, the theory of the fixity of bacterial 
species and that of the "antibodies" ornamented 
with "side-chains" such as would explain recovery 
and all immunity. Suddenly bacteriophagy made its 
i I appearance. The structure could not support die 
added weight of the new facts: it crumbled. The 



cellular theory of life is manifestly false, for life 
is an attribute of intracellular particles. The anti- 
bodies play no part in the phenomena of recovery. 
The form and the properties of bacteria are in- 
herently variable characters. 

Frankly, d'Herelle seems now almost 
more a throwback to the nineteenth cen- 
tury — the "period of blissful satisfaction," 
as he termed it — than a member of the 
scientifically sophisticated twentieth cen- 
tury — the period of the cautiously quali- 
fied claim. Both his bold and unequivocal 
assurances of cure and his heroic develop- 
ment of an entire revolutionary system 
upon one series of observations seem oddly 
foreign to modern medical procedure. 
Coming as it did while Ehrlich and his 
followers were gradually building the 
science of immunology, d'Herelle's pro- 
posal of a heterodox, completely-contained 
bacteriophagic theory of disease and re- 
covery was almost atavistic. Perhaps 
Felix d'Herelle, like those practitioners 
who tested his therapy, was a kind of 
transition figure. Not quite twentieth cen- 
tury, he had learned the methods and con- 
ventions of the new century's science, but 
retained from an earlier era of medicine an 
uninhibited sense of personal assertion. 

NOTES AND REFERENCES 

1. d'Herelle, Felix: The Bacteriophage and Its 

Clinical Applications. Charles C Thomas, 
Springfield, Illinois, 1930. (Translated by 
George H. Smith.) 

2. Like many other bacteriologists, d'Herelle had 
noted occasional spontaneous lysis in broths and 
had bqgun a systematic search for the phenome- 
non early in his career. This was interrupted by 
World War I, which saw d'Herelle and other 
microbiologists preparing sera, etc. Frederick 
William Twort reported the bacteriophage phe- 
nomenon in 1915, though d'Herelle later insisted 
his discovery and Twort's were not the same 
thing. 

3. d'Herelle, F.: Sur un microbe invisible antago- 

niste des bacilles dysenteriques. Comptes 
Rendus Acad. Sci. 165: 373, 1917. 

4. d'Herelle later assigned the name "Protobios 
bacteriophagus" when the phenomenon was seen 
to extend beyond only enteric bacteria. Years 



122 



STEVEN J. PEITZMAN 



later, the drug firms were unjustifiably accused 
of coining the term "bacteriophage" in order to 
convey the idea of a bacteriocidal action. 

5. d'Herelle, F.: Le Bacteriophage. Son rdle dans 

Vimmuniti. Masson, Paris, 1921. 

d'Herelle, F.: The Bacteriophage: Its R6le in 
Immunity. Williams and Wilkins, Baltimore, 
1922. (Translated by George H. Smith.) 

Later versions: 

d'Herelle, F.: The Bacteriophage and Its Be- 
havior. Williams and Wilkins, Baltimore, 1926. 
(Translated by George H. Smith from the 
French version, Le bacteriophage et son com- 
portment, 1926.) 

d'Herelle, F.: The Bacteriophage and Its Clini- 
cal Applications. Springfield, Illinois, 1930. 
(Translated by George H. Smith, but appar- 
ently never published in original French. 
"Each of the chapters of the text corresponds 
to one of the Lane Lectures, delivered at 
Stanford University, in October of 1928." — p. 
vii.) 

d'Herelle, F.: Le phdnomene de la gucrison dans 
les maladies infectieuses. Masson, Paris, 1938. 

6. da Costa Cruz, J.: Le traitement des dysenteries 

bacillaires par le bacteriophage. Comptcs. 
Rendus. Soc. Biol. 91: 845, 1924. (Quoted and 
translated in d'Herelle, 1926, English edition.) 

7. Davison, W. C: The bacteriolysant therapy of 

bacillary dysentery in children. Am. J. Dis. 
Children 23: 531, 1922. 

8. See d'Herelle, 1926, English edition, chapter 6. 

9. This extensive work was fully reported in a large 
monograph: 

d'Herelle, F., Malone, R. H., and Lahiri, M. 
X.: Studies on Asiatic Cholera. Indian Medical 
Research Memoirs, no. 14, 1930. 

10. See d'Herelle, 1930, chapter 5. 

11. Note 5. 

12. d'Herelle, 1930, p. 237. 

13. It was fairly widely believed that bacteriophage 
in the blood had an opsonic effect. 

14. d'Herelle, 1930, p. 242. 

15. The following sources provided information 
about the commercial bacteriophages: 

Straub, Marcaret E., and Applebaum, Martha: 
Studies on commercial bacteriophage products. 
J.A.M.A. 100: 110, 1933. 

E. R. Squibb & Sons: Physician's Reference Book 
of Squibb Biological Products and Pharma- 
ceutical Specialties. New Brunswick, N.J., 1935 
and 1941. 

Lilly Research Laboratories: Distinctive Prod- 
ucts. Indianapolis, 1932. 

Eli Lilly 8c Co.: De re medicina. Indianapolis, 
1938, 1941, 1951. (This is just a catalogue of 
products.) 

Anglo-French Drug Co.: Therapeutic Uses of 



Bacteriophage (d'Herelle). [New York, 1932?] 
(An undated advertising pamphlet, probably 
1932.) 

16. Note 15. 

17. Commercial Aspects of Bacteriophage Therapy. 

(editorial). J.A.M.A. 100: 1603, 1933. (Other 
interesting J.A.M.A. editorials, both titled, 
"Limitations of Bacteriophage Therapy," may 
be found in J.A.M.A. 96: 693, 1931, and 98: 
1190, 1932.) 

18. [Editorial comment] Lancet 2: 198, 1932. 

19. Eaton, M. D., and Bavne-Jones, S.: Bacterio- 

phage Therapy. Special Report of the Council 
on Pharmacy and Chemistry. J.A.M.A. 103: 
1769-76, 1847-53, 1934-9; 1934. 

The later A.M.A. Council on Pharmacy and 

Chemistry reports discussed are: 

Krelt.er, A. P., and Scribner, E. J.: Bacterio- 
phage Therapy II. Bacteriophage: Its nature 
and its therapeutic use. J.A.M.A. 116: 2160-7, 
2269-7, 1941. 

Morton, Harrv E., and Encley, Frank B.: 
Dysentery Bacteriophage. Review of the litera- 
ture on its prophylactic and therapeutic uses 
in man and in experimental infections in ani- 
mals. J.A.M.A. 127: 584, 1945. 

20. E.g.: ". . . Failure et la gucrison des maladies in- 
fectieuses chez l'individu isole-, aussi bien que la 
marche et la cessation des epidemies, sont sous sa 
dependance directe." (from I" Congres Interna- 
tional de Microbiologic: Resumes de Rapports, 
Conference et Demonstrations. Paris, 1930.) 

21. The Russians continued experimenting with 
bacteriophage therapy long after the rest of the 
world had given up, actually into the late 1940's. 
They published several articles during World 
War II reporting treatment of battlefield wound 
infections with phage. 

22. Note 19. 

23. As one bacteriophage therapist in India wrote: 
"In a disease so fatal as cholera, the evaluation 
of the use of bacteriophage on alternate cases in 
villages is not possible. It would certainly result 
in a riot should one form of treatment seem less 
efficacious than another." 

24. Morlson, J., and Vardon, A. C: A cholera and 

dysentery bacteriophage. Ind. J. Med. Res. 
17: 48, 1929. 

25. Compton, A.: Antidysentery phage bacteriophage 

in treatment of bacillary dysentery; record of 
66 cases treated, with inferences. Lancet 2: 
273, 1929. 

26. Though therapeutic application of bacterio- 
phage proved valueless, its later use in typing 
and genetic research has lent enormous im- 
portance to the discovery of Twort and d'Her- 
elle. 

27. See d'Herelle, 1930, preface, p. v-vi. 



FELIX n'HERELLE AND BACTERIOPHAGE THERAPY 



123 



Other sources consulted: 

Adams, Mark H.: Bacteriophages. Interscicncc Pub- 
lishers, New York, 1959. 

Ackerknecht, E. H.: A Short History of Medicine, 
revised edition. Ronald Press Company, New 
York, 1968. 



Lewis, Sinclair: Arrowsmith. Harcourt, Brace and 
World, New York, 1952 (Originally published 

1925). 

Obituary notices of Felix-Hubert d'Herelle: 
Nature 163: 984, 1949 (by Compton). 
J. Int. Coll. Surg. 12: 597, 1949. 
Ann. Inst. Pasteur 76: 457, 1949 (by Pierre Lepine). 



The Public Practice of Midwifery 
in Philadelphia 

By W. ROBERT PENMAN, m.d. 1 



IN Philadelphia, Pennsylvania, in 1835, 
pregnant poor women had extreme 
difficulty in obtaining any kind of care 
for their confinements. 

At that time in the city, there were only 
two institutions offering "public" service 
to the poor: the Lying-in Department of 
the Pennsylvania Hospital and the Phila- 
delphia Almshouse (or "Blockley," as it was 
sometimes called after it moved to its 
present location in Blockley Township in 
1834). 

Both institutions had limited facilities 
and could not service the needs of the poor 
women of Philadelphia, nor did these in- 
stitutions have the confidence of the poor. 
People knew that when women went there 
for their confinements they might die from 
puerperal infection or "child bed fever." 
Those who could not avail themselves of 
the public service of these two institutions 
might be cared for by the Philadelphia 
Lying-in Charity, established in 1828 by 
Dr. Joseph Warrington 2 . Several small 
dispensaries, including the Philadelphia 
Dispensary, arranged for doctors to de- 
liver women in their homes. The poor 
were thus badly cared for, and dedicated 
physicians of Philadelphia were profoundly 
disturbed. 

Dr. Jonas Preston was one of the leaders 
in the movement to correct this situation. 
Born in Chester County, Pennsylvania, in 

1 20 State Road, Paoli, Pennsylvania 19301. 

2 Joseph Warrington, m.d., (1805-88) received his 
medical degree at the University of Pennsylvania in 
1828. In addition to organizing the Lying-in Charity 
of Philadelphia, Warrington wrote treatises on nurs- 
ing (1839) and obstetrics (1842). See also Henry, F. P.: 
Standard History of the Medical Profession of Phila- 
delphia. Chicago, Illinois, 1897, p. 420. 



1764, the son of a Quaker physician, he 
was instructed in the practice of medicine 
by Dr. Thomas Bond of Philadelphia and 
became a successful practitioner of mid- 
wifery in Chester, Pennsylvania, later 
moving to Philadelphia in 1812. He was a 
member of the legislature for many years, 
serving both in the Assembly and the 
Senate. After moving to Philadelphia, he 
took an active interest in several institu- 
tions in the city, such as the Pennsylvania 
Hospital, Friends Asylum, Penn Bank, and 
the Schuylkill Navigation Company. He 
was an excellent and shrewd businessman 
and was able to amass a substantial fortune 
through wise investments, in real estate 
and other ventures, of his own money and 
his wife's inheritance. He was very active 
in the Schuylkill Navigation Company 
and also had extensive real estate holdings 
in Norristown, Pennsylvania (1, 2). In his 
will made out in 1834, he noted the des- 
perate plight of the poor pregnant women 
of the city and stated "that there ought to 
be a lying-in hospital in the city of Phila- 
delphia for indigent married women of 
good character distinct and unconnected 
with any other hospital where such fe- 
males may be received and be provided 
with proper obstetric aid for delivery, 
etc." (3). 

He bequeathed a sum of four hundred 
thousand dollars for the founding of such 
an institution. He died in 1836, and im- 
mediately the trustees of the will at- 
tempted to implement his directive. In 
order to obtain the experience and the 
advantages of the lying-in hospitals of 
Europe, the Board of Managers hired Dr. 
James Bryan to go to Europe for such a 



124 



THE PUBLIC PRACTICE OF MIDWIFERY IN PHILADELPHIA 



125 



survey 3 at a cost of $500 (4). The trustees, 
cognizant of the vastness of the problem 
and also aware of their ignorance of the 
situation, had on August 2, 183G, re- 
quested by letter that a committee of 
physicians from The College of Physicians 
of Philadelphia be appointed to investigate 
the subject and make recommendations 
for the proper construction of a lying-in 
hospital. The committee of the "Preston 
Retreat" consisted of John M. Ogden, 
John M. Frailey, James Martin, Philip 
Price, and Samuel Maydoch. The College 
of Physicians immediately appointed a 
Standing Committee on Midwifery, with 
Charles D. Meigs 4 , Chairman, and Doctors 
Kuan 6 , Huston 6 , and Gebhard 7 , members. 
This committee replied to the Preston Re- 
treat on November 15, 1836 (5). 

The report is cogent, thorough and 
timely. The correspondence and the report 
of The College of Physicians are printed 
here in their entirety. 

TO THE COLLEGE OF PHYSICIANS OF PHILADELPHIA 

Respected Friends: 

The undersigned are a committee of the 
Preston Retreat, to procure plans for a suitable 
building or buildings for that institution. They are 

s The Bryan report was made after the Meigs re- 
port. Bryan investigated European hospitals in 
1838—40, sending back multiple reports. He also 
supplied comments while the building was being 
erected. He became professor of surgery at the medi- 
cal school in Castleton, Vermont, from 1840-44. 

'Charles D. Meigs, m.d., (1792-1869) received his 
medical degree at the University of Pennsylvania in 
1817 and went on to become professor of obstetrics 
and diseases of children at Jefferson Medical College. 
He was also famous as an adversary of Oliver 
Wendell Holmes. See Kelly, H. A., and BurTage, W. 
L.: American Medical Biographies. Baltimore, 1920, 
p. 777. 

3 John Ruan, m.d., (1771-1845) received his medi- 
cal degree at Edinburgh, Scotland. 

"Robert Huston, m.d., (1794-1864) received his 
medical degree at the University of Pennsylvania in 
1825 and held Meigs' position in 1838. 

7 Lewis Gebhard, m.d., (1791-1873) received his 
medical degree at the University of Pennsylvania in 
1813. 



fully impressed with the importance of so con- 
structing the Hospital as most effectually to guard 
against the spread of those diseases to which females 
are liable during the period of their confinement. 
In order to perform the responsible duty devolved 
upon them in the best manner the committee are 
anxious to receive all the information that can be 
imparted by those who have had experience and 
occasion to reflect upon the subject of their enquiry. 
By the Medical Faculty they must chiefly expect to 
be enlightened, and they appeal to you as an 
organized body of the Profession, from whom they 
may expect the most important suggestions to guide 
them to their conclusions. The lot that has been 
selected for the Preston Retreat is a large square of 
ground, upwards of 490 feet in length by upwards 
of 417 feet in width, with wide streets on two sides, 
the lot and surrounding streets comprising an open 
area of more than eight acres, on a high gravel soil 
that will secure dry foundations. The main building 
will face southward on Hamilton Street between 
Schuylkill, Second, and Third Streets. 

We most respectfully ask of you to (give) 
the subject your careful attention and shall be grate- 
ful for all the light you may shed upon it. 

We are very respectfully, 
Your friends 

John M. Ogden, 
John M. Frailey, 
James Martin, 
Philip M. Price, 
Samual Maydoch, 

8 mo (Augt) 2, 1836 

• • • 

Philadelphia, Dec. 5, 1836 

Dear Sir: 

I beg leave to hand you, for the Trustees of the 
Preston Retreat, a report of a committee of The 
College of Physicians, of Philadelphia. The Com- 
mittee consist of Drs. Meigs, Ruan, Huston, and 
Gebhard. The report was drawn up in obedience to 
a resolution of the college; and when considered, at 
the Meeting held on the 15'* of last month, it was 
directed to be presented to your Trustees, and ac- 
companied with such verbal explanations as we 
might deem expedient. 

At the same meeting, the following resolution was 
passed, and directed to be handed to the Trustees 
of the Preston Retreat. "Resolved, that this college 
recommend to the Trustees of the Preston Retreat, 
the erection of a principal building for offices etc., 
with one or more flank buildings for the accomoda- 
tion of patients, detached from the main building; 
to consist of a range of rooms, open back and front, 
so as to allow of the most ventilation." 

Should the Trustees of the Preston Retreat think 



126 



W. ROBERT PENMAN 



proper to ask for verbal explanations, I shall thank 
you to signify their wishes to me; when I shall take 
pleasure in calling our committee together for that 
purpose. 

I am, dear Sirs, 
with the greatest respect, 
Your obedient servant, 
Ch. D. Meigs, 

To Mr. Ogden 

COLLEGE OF PHYSICIANS 

Philadelphia, Nov. 15, 1835 
The Committee of the College, to whom was re- 
ferred a letter from John M. Ogden and others, a 
committee of the Preston Retreat Society, report 
that, 

The benevolent Founder of the Lying-in Hos- 
pital, about to be erected in our City, was desirous 
that the Charity which bears his name, should 
furnish to parturient women, not only all the aids 
that are esteemed indispensable for their security 
and comfort, whilst in travail, and the care and 
watchfulness over them, required during the period 
of convalescence; but also, an immunity, as far as 
practicable, from those disorders that are most 
likely to spread, in similar institutions, and which 
have rendered many of them Pest Houses, rather 
than Asylums, or Retreats from the dangers and 
anxieties of the puerperal state. 

In constructing a house, or houses for the use of 
Dr. Preston's Retreat, it was thought incumbent on 
the gentlemen charged with that important trust, to 
inquire into the sources and causes of danger to 
women congregated in such establishments; and they 
have, accordingly, applied to the College, as a 
Corporate Scientific Body, to whom they might, with 
confidence look for correct and judicious opinions 
upon the subject. It would be easy to reply to the 
inquiry thus addressed to the college, in a few 
words; and it would probably be the unanimous 
opinion of the body that the disorder most sedu- 
lously to be guarded against, as such as are found 
to arise from the collecting a great number of 
puerperal women within the walls, and under the 
one roof, of the same building; and such as depend 
upon keeping a lying-in apartment always occupied 
without intervals of time during which it ought to 
be completely vacated, cleansed, and ventilated; and 
further that the disease which is esteemed to be 
most dangerous, and most likely to spread is 
Puerperal Fever, better known to the public by the 
title of Child Bed Fever. 

Notwithstanding this disorder is in its nature 
most dangerous and the consideration of it alone, 
would demand the wisest precautions against its 
introduction and spread in the hospital, there are 



several other maladies, that may, upon occasions, 
get footing in a badly constructed hospital, and 
become productive of extreme distress, and even of 
great mortality; particularly, if all the wards should 
be covered by the same roof, and admit not of a 
complete isolation and purification. It is sufficient, 
in this connection to mention scarlet fever, whoop- 
ing cough, measles, varioloid, and Trismus of in- 
fants, and of which by spreading among the inmates, 
would serve to bring reproach upon the Foundation, 
diminish its usefullness, and cause many to fall 
victims, who might escape, but for the misfortune 
of having entered an ill constructed retreat from 
dangers which they might avoid at their own homes: 
Such diseases might be rife in the hospital, without 
any extensive prevalence of them among the other 
population of the city. Great good can be done in 
this community by furnishing to the inmates of the 
Preston Retreat, all the aids and comforts appropri- 
ate to their condition, and the true design of the 
worthy founder will in so far be fully attained and 
fulfilled; but if a faulty plan should be adopted, 
the attack and spread of dangerous diseases will be 
so far invited and promoted, that their occasional 
appearance there in, will be inevitable, the Will de- 
feated, and his munificence become an injury and 
a mockery to the poor, rather than a great blessing 
as he most piously and humanly desired. 

Under what circumstances then, are parturient 
women found to be most secure from the dangers 
of Childbirth? It is invariably admitted that 
parturition is accompanied with very little mortality 
in private practise. The mortality varies according 
to the season, as healthy or sickly, and to the range 
of the cases, as occuring in the higher, the middleing, 
or the lower walks of life; being greatest in the 
latter, on account of the want of many comforts, or 
necessaries as to lodgings, food, clothing, ventilation, 
etc.; but, in all these walks, the security is very great 
in private practise. 

The contrary obtains, where many women are 
confined under the same roof; or where they follow 
each other in constant succession as tenants of the 
same wards of a hospital; for not only is there, under 
such circumstances, a great proneness in the women 
to be affected with childbed fever; but, the infants 
of the house are also the frequent victims of Tris- 
mus, or nine day fits. These disorders are not only 
more common, but far more fatal and unmanagable, 
in the hospital, than in private practise; and can 
only be effectively obviated or prevented in the very 
place, and design, for the erection of the hospital. 

In as much, therefore, as private confinements are 
safest both for mother and their tender offspring, it 
is impressed upon your committee as one of the 
most important and evident facts in this relation, 
that all lying-in establishments ought to be made as 
far as possible, conformable in respect to comfort 



THE PUBLIC PRACTICE OF MIDWIFERY IN PHILADELPHIA 



127 



and security, to the private dwelling, and dispense 
all the advantages of the accouchement at home. 
They consider that no cleanliness, no mere ventila- 
tion, no regulations, should be deemed sufficient 
guarantees against the introduction and spread of 
puerperal fever in a great Lying-in Hospital, all the 
wards of which are included with in the same walls, 
and even by the same roof. There is sufficient both 
of reason and authority, to convince us, that, the 
poisonous air once generated in the house, passes 
along the corridors ascends the stairway and infects 
the building from the basement to the highest 
stories. Without pretending to determine what is 
the nature of the poisonous exhalation, or whether 
indeed, it be a substantive poison that produces 
these effects, past experience warns us of profuse 
dangers, and exhorts us, when about to lay a new 
foundation, for the benefit of succeeding generations, 
to attend to the dictates of reason and prudence and 
to depart from the old and vicious methods, by 
adopting a new one likely to make the house forever 
secure from the common reproach of similiar in- 
stitutions. Your Committee are free to say that the 
Preston Hospital ought never to deserve the name of 
Pest House, considering the light possessed upon the 
subject at the present day, and the ample means 
appropriated for its erection on an improved plan. 

In addition to setting forth the advantages of 
private practise as to the greater security of patients 
it behooves the Committee to lay before the College 
some statements of the results of the Public, or 
Hospital practise of midwifery and for this end they 
beg leave to submit the following table which they 
have taken from the valuable publication recently 
made by Dr. Collins, late Master of the Dublin Ly- 
ing-in Hospital. It comprises a statement of the 
causes of death, in one hundred sixty four women, 
who died there, out of sixteen thousand four hun- 
dred and fourteen females delivered in the house, 
during the seven years of Dr. Collins' Mastership. 

From Dr. Collins' table it appears that fifty nine 
out of the one hundred and sixty four deaths, more 
than one third of the mortality were occasioned by 
puerperal fever alone; and that, during a period 
when no very great or extraordinary prevalence of 
the malady existed, Dr. Collins remarks that, of the 
16,414 women delivered, one hundred sixty four 
died, or one in a hundred; but, he says that if we 
deduct the deaths from puerperal fever which may 
be considered accidental, the proportion is greatly 
diminished; \iz. to one in one hundred fifty de- 
liveries; and again, if we abstract those deaths 
from causes, not the results of child birth, marked x 
thus in the Table, the mortality from effects arising 
in consequence of parturition is reduced to one in 
two hundred forty four cases. 

The Committee think that the data obtained in 
the above Table are highly worthy of the attention 



TABLE 



x Diarrhoea I 

x Typhus Fever 5 

Rupture of uterus or vagina 32 

Uterine I hemorrhage II 

x Puerperal Fever 59 

x Inflammation of Brain 3 

x Ulceration of Intestines 3 

x Hectic fever I 

x Grief, apparently 2 

x Stricture of intestines 1 

Effect of tedious and difficult 1 1 
labor 

Convulsions 2 

x Hydrothorax 2 

x Pericarditis I 

Peritoneal Inflamm 

The Placenta retained 4 

x Abcess in Spinal Canal 1 

x Lumbar abcess I 

x Phthisis 2 

x Acute bronchitis 1 

x Anomalous disease 12 

x Diffuse inflammation 1 

x Abcess in Abdoman 2 

Sloughing of vagina 6 



of the Preston Retreat Society as obtained in a 
hospital acknowledged, in general, to be the most 
admirably managed and it might suffice for the 
purpose of their information were it not that other 
places and institutions have been less fortunate. 

For example, in the years 1819 and 1820 there 
were delivered in the Maternite at Paris 4924 of 
whom 1177 were attacked with puerperal fever, 
nearly half of which cases proved fatal. Tenon, who 
has written a memoir on the Hospital of Paris, 
shows that in the Hotel Dieu, from Jan. 1, 1779 to 
Dec. 31, 1780 there died one in fifteen and two 
thirds of the women delivered in that hospital. 

The younger Baudelocque has also calculated the 
mortality oj: the Maison de Accouchements for a 
period of 11 years from Jan. 1, 1814 to Dec. 31, 1824, 
and informs us, that, one woman died out of some- 
what less than every 22 delivered. According to the 
same author, the mortality was nearly the same for 
several other periods; for example in 31 years, there 
were confined at the Maison de Accouchements 
61,647 of whom 2777 died, or one in twenty one and 
a fraction. 

In a printed abstract of the Registry kept at the 
Lying-in Hospital in Dublin, we observe that from 
Dec. 8, 1757 to Dec. 31, 1828, there were admitted 
123, 790 women of whom 1420 died or one death in 
eighty nine admissions. 

There are numerous statements of average mor- 



128 



W. ROBERT PENMAN 



tality, and of mortality under peculiar circumstances 
which it would be useless and tedious to cite here; 
but, we shall not overlook a pamphlet entitled, 
"Some Accounts of the Pennsylvania Hospital," in 
one of the pages of which we learn that, the Ly- 
ing-in Department of that house as established in 
1803, and that up to the 28 th of April 1832, there 
had been admitted 747 women, 54 of whom left the 
house undelivered making a total of 693 women de- 
livered in that Department. Of those women 35 
died; or one in 19 */$ nearly, of all the patients. 

These calculations of Hospital results, are ex- 
tremely important but we think that an inference 
particularly instructive may be drawn from the 
astonishing difference in the Dublin and Phila- 
delphia Houses; it is this, that where many sick 
individuals are congregated under the same roof, 
disease is prone to break out, and spread among 
them, and prove rebellious under medical treat- 
ment. It is not improbable, that the epidemics of 
puerperal fever, that have on several occasions, 
desolated the Lying-in Ward of the Pennsylvania 
Hospital may be satisfactorily traced to some con- 
nexion with Erysipelas, which at times is found to 
infest the wards of that Establishment; evincing an 
impure state of the air under that roof, notwith- 
standing the greatest precautions that are there 
adopted, on the subject of cleanliness and ventila- 
tion, equal, perhaps, to what are found in the best 
private dwellings. The whole number of persons 
under medical and surgical treatment there is or- 
dinarily rising of two hundred, and the erysipelas 
which occasionally afflicts them, is on reasonable 
grounds, suspected of having a cause, common to it, 
and to the child bed fever. 

To show how far the congregation of many pa- 
tients within the same enclosure may, by inference, 
be accused of producing very pernicious tendencies 
among them, it may be properly mentioned here, 
that the Dublin Lying-in Hospital is thought to be 
one of the best institutions of the kind in the world. 
The building is of three stories, each floor divided 
by a spacious corridor, extending through the house, 
length wise and bisected by the stair ways; which 
gives twelve large wards, each provided with 8 or 10 
beds. There are two other small wards at the end of 
the edifice. Now, this house, tho capacious, admir- 
ably ventilated and scrupulously clean, has been the 
seat of the most fatal epidemics of Child Bed Fever. 
That disease has prevailed there, in the years, 1767, 
1774, 87, 88, 1803, 10, 11, 12, 13, 18, 19, 20, 23, 26, 28, 
and 29. In the epidemics of 1819 and 1820 alone, 
there died, 114 women. 

All experience indeed, goes to confirm the opin- 
ion that a great many lying-in women ought not to 
be assembled in one building; and that pregnant 
females ought not to continue inmates of wards con- 
taining the occult causes that predispose them to 



the assault of the disease in question. Universal ex- 
perience teaches, further, that once established in 
the wards the causes can not be easily ejected or 
eradicated, by washing or scrubbing, by chlorine, by 
fumigation, by painting, lime, washing, nor, in short, 
by any known means except the vacation of tfie 
apartments, and the suspension of its usefullness for 
a greater or less duration of time — such a room is 
forbidden ground for pregnant women; if they in- 
habit it, they acquire in it the fatal predisposition 
whose development and lethal powers, only demand 
the throes and excitement of labour, or some of the 
slight affections generally ensueing childbirth. 

It is well known here, that this predisposition 
has been fatal in the Pennsylvania Hospital, and the 
cause so previously seated in the Lying-in Ward* 
that they have on several occasions been, through 
necessity, entirely closed against patients for a long 
time together. Thus suspending the functions of 
Charity. The disease has reappeared among the first 
admissions and the Managers, most wisely and hu- 
manly, at length resolved to place the Lying-in 
Departments in a separate building — which is the 
reason why patients have now for some time been 
accommodated pleasantly and we hope safely, in the 
basement story of the West's Picture House. 

Your Committee do not esteem it, apart of their 
duty, further to review the history of Epidemic 
Puerperal Fever. They conceive it to be a settled 
opinion among medical men that child bed fever 
and Trismus are the bane of such establishments, 
and are prone to excessive violence in proportion 
to the want of fresh air, the absence of cleanliness, 
and the populousness of the wards that are formed 
under a single roof. It would be an easy task for 
them to detail the melancholy history of the malady, 
but, the Table representing the causes of death in 
the 104 victims at Dublin, already submitted leaves 
perhaps, with sufficient cleanness to set forth what 
are the ordinary disorders attendant on parturition 
and what important influences may be exerted in 
favor of the patients, by a judicious arrangement of 
the house, in its original plan. 

A few reflections upon the probable wants of our 
community in reference to the comfort and protec- 
tion of poor lying-in women, seem to us so oppor- 
tune for the present occasion, that we shall seize it 
to lay before the College our views in relation 
thereto. 

There are but two lying-in Hospitals in Phila- 
delphia, one of which is the Lying-In Department 
of the Pennsylvania Hospital and the other the 
Lying-In Wards of the Philadelphia Almshouse. 
There should be taken, also, into consideration the 
Philadelphia Lying-In Charity, which provides for 
attendance upon sick at their own houses; and some 
females are relieved by the several dispensaries, 
upon application made at their offices. 



I I IK P115LIC PRACTICE OF MIDWII KRY IN l'1 1 1 1 . A I ) III' 1 1 1 A 



129 



The Pennsylvania Hospital and the Almshouse 
relieve about one hunched and fifty annually and 
the other institutions above named probably re- 
lieve an equal number; so that it appears the Public 
Charity of Philadelphia caters to about 300 women 
in labour per annum. 

The total number of children born here in a.d. 
1835 was 7856, as ascertained from the returns to 
the Health Office , made by 170 practitioners of 
midwifery. Computing then, that there were de- 
livered in that year 7856 women, the 170 practi- 
tioners would each have 40 obstetric cases per year, 
if they were equally divided among them; but, 
some medical persons have 200 patients per year, 
others 100, 90, 70, etc., leaving to many of their 
bretheren but a few cases in that branch of prac- 
tise, for which so eager a competition exists, and 
which is supposed to lead to the highest success in 
medicine, more certainly than any other depart- 
ment of practise. It is supposedly under such cir- 
cumstances, that puerperal women will often be 
left to suffer for the comforts and aids that pro- 
fessional men alone can give, or that many exam- 
ples will be found in this community of women 
applying in vain for medical assistance in the trying 
hours of travail or in a subsequent confinement and 
indisposition, or illness. We are too well acquainted 
with the liberality of our brethren to suppose it 
possible. 

To show that our poor do not lack, for as- 
sistance on these occasions, it is sufficient to state 
that, the comforts and accomodations of the Lying- 
in Department of the Pennsylvania Hospital great 
as they are, are yet incapable of attracting more 
than about 60 women there in each year, which 
could not be the case were the wants of that class 
of patients more pressing than they are at present. 

Let the above specified circumstances have due 
weight, and they will convince the College that the 
new Hospital will not, probably, be crowded with 
patients for some years to come; and consequently, 
will not for some time require the erection of very 
expensive buildings; considering too, that complete 
isolation of the wards affords the surest means of 
obviating the spread of disease; that, if the disease 
should epidemically attack the inmates, it could 
only be eradicated by closing the house for a season, 
thus interrupting or suspending the Charity (sup- 
posing it to be contained in a single house). Lastly 
considering that many years must elapse before the 
demand for aid shall become clamorous, in this 
community, we feel convinced, that, if guided only 
by views of the personal accommodation of each 
woman we ought to recommend the construction of 
a number of small houses, so as to give each woman 
a separate lodge. Such a plan as this, however, we 
can not bring ourselves to recommend in the present 
instance, for many reasons, in addition to those 



connected with the greater cxpensiveness of such 
a method. There may be several good methods of 
arranging the Hospital buildings, either of which 
could with propriety be selected by the Preston 

Society. 

The Committee, not being in possession of the 
requisite knowledge and taste in Architecture, have 
had conversations with an eminent person in that 
profession in order to ascertain whether the most 
fastidious taste could not be fully gratified in the 
erection of several small buildings, instead of one 
principal structure. They were pleased to learn 
that a good architectural design would not be in- 
compatible with the erection of a central building, 
on the south front of the lot, and of several de- 
tached edifices on a line with it ranging east and 
west. These buildings might be 38 by 40 feet square, 
two stories high, with marble fronts, divided by a 
blank wall from north to south, giving four rooms 
on each floor, communicating by a door between 
the north and the south rooms, but admitting of no 
communication between the east and west room. 
Piazzas on the northwest, north, and northeast sides 
of the buildings would afford a sufficient promenade 
for the patients, and admit of a convenient access 
to the upper floor without any direct communica- 
tion of the lower with the upper wards. 

The west, north, and east windows should be 
constructed so as to open out on the piazzas, by 
opening on hinges, with ventilation shutters on the 
outside. The south windows should be made in the 
ordinary manner of constructing sash. A center 
building might be used as office-residence for the 
Steward and Matron, and apartments for women 
waiting for the period of their pregnancy and for 
other purposes. With one center building, and two 
out buildings of the form and size indicated, the 
hospital could go into early operation. The out 
buildings would cost 5,000 dollars each; and the 
principal edifice could also be constructed for a 
moderate sum if divested of useless moment. 

Each out building would accommodate 16 pa- 
tients, having eight wards, in each of which two 
patients would be accommodated. As the north and 
south wards would communicate with each other 
by a door, one nurse could conveniently take care 
of four women and four children. Eight nurses 
therefore, would serve the whole hospital, even sup- 
posing two out buildings to be completed and to 
contain as many as 32 women and an equal number 
of children. It is highly probable, however, that a 
smaller number would suffice for years to come. 

Should the above plan be adopted, it is reason- 
able to conclude that if well administered, it could 
for ever be kept free from the epidemic which is 
most to be feared and guarded against. A perfect 
security would probably follow that adoption of 
the method now used at the Dublin Hospital — 



130 



W. ROBERT PENMAN 



videl. The wards should be numbered 1 to 16, and 
used in succession, no ward to be made use of after 
having received and discharged its confinement, 
until every other ward, has been likewise filled and 
emptied. During the time of each apartment being 
unoccupied, it could be thoroughly cleaned and 
ventilated, and freed from all infections or mias- 
matic exhalations — or it could be sequestered from 
the establishment for weeks or months, without 
interfering with or in any wise suspending the 
general and beneficicnt functions of the whole 
Charity. 

The lot on Hamilton Street is large enough to 
admit in future times, of the construction of ranges 
of separate buildings on each of its sides, sufficient 
in number to accommodate the poor lying-in women 
of an immense capitol. 

If that lot should retain its present lofty eleva- 
tion, instead of being reduced to the common level, 
its sides might be supported by a wall of stone, and 
the buildings could then have for their site a noble 
terrace, which would raise them above all the sur- 
rounding edifices, exposing them to the fresh 
ventilation and presenting a most attractive spec- 
tacle in their simplicity, symmetry and order, as 
well as the beauty of the material of their several 
fronts. The centre would compose a court or garden 
adorned with trees, shrubs, and grass, both con- 
ducive to the beauty, salubriousness, and comforts 
of the institution. Such an Hospital would be 
highly attractive to the better set of poor patients; 
it would be healthy, private, easily administered; 
without the noise and confusion of a single edifice; 
cheap in construction, and capable of a gradual 
extension, proportion to the increasing wants of the 
community in future years or generations and 
leaving an ample remainder of the Preston legacy, 
for the entire comforting and accommodation of the 
sick. 

Should the Committe of the Preston Society on 
the other hand resolve to build a single house; then 
the committee recommends the adoption of a plan 
similar to that of the City Hospital on Bush Hill; 
have a principal building with detached wings, two 
stories high and 20 or 22 feet in depth, admitting 
of the erection of a number of wards of 17 or 18 
feet by 20 or 22 feet — the south front provided with 
piazzas, above and below as is observed at the City 
Hospital. 

A Hospital erected on this plan presents many 
advantages as to accessibility and the desirable iso- 
lation by means of blank walls earned up from the 
cellars to the roof, being each alternate %vard — 
which ever of the methods may be chosen. Your 
committee will feel satisfied that the Directors will 
have acted with wisdom and humanity, in adopting 
in either case a method that must most certainly 
obviate the shocking occurance of epidemic puer- 



peral fever, which no medical or other person, 
who has witnessed such an indomitable disorder, 
could think of with out discomposure. 

V'our Committee having laid before you what they 
consider correct principals in the important ques- 
tions submitted to their consideration deem that 
their task is now fulfilled, without entering into 
many minute details, as to the arrangement or 
placing of doors, windows, fireplaces, etc., etc.. They 
will find themselves at all times happy, in being 
enabled to give their opinions upon those subjects, 
if invited to do so by the Preston Retreat Com- 
mittee. 

Which is respectfully submitted. 

Charles D. Meigs, Jr., Chairman 

The Standing Committee on Midwifery 

The Board of Contributors of the 
Preston Retreat whole-heartedly accepted 
the report of the Standing Committee on 
Midwifery of The College of Physicians 
and began to implement it immediately. 
On June 13, 1836, the Preston Retreat Bill 
was presented to the Senate in Harrisburg, 
Pennsylvania. The Senate and House of 
Representatives in the General Assembly 
in Harrisburg appointed 114 members to 
the Board of the Preston Retreat and in- 
corporated it as a Society. The members 
had to pay $5.00 per year or $30.00 as a 
life contribution. The affairs of the Insti- 
tution were to be conducted by a Board of 
Managers of 24 Contributors to be elected 
annually by ballot the second Monday in 
January of each year. The Board of Man- 
agers, in turn, were to appoint a Visiting 
Committee of twelve respectable females 
from the City and County of Philadelphia 
and the County of Delaware. This com- 
mittee had power to select and remove 
physicians, nurses and other assistants from 
the Institution. 

The ground upon which the Preston 
Retreat was to be built was purchased on 
August 1, 1836 from John McAllister for 
537,000. It consisted of eight acres and was 
between Hamilton and Morris Streets, the 
Schuylkill River and Third Street in the 
District of Spring Garden. John Sergeant 
was the lawyer handling the transactions 
for the Preston Estate. Four architects 



THE PUBLIC PRACTICE OF MIDWIFERY IN PHILADELPHIA 



131 



were invited to submit plans for the Re- 
treat. On February 20, 1837 the Preston 
Board appointed Thomas U. Walter to be 
the architect, and the Standing Committee 
on Midwifery of The College of Physicians 
nuclei the Chairmanship of Charles D. 
Meigs accepted the design. The corner- 
stone was laid on July 17, 1837. 

Construction was immediately delayed 
because the marble from the Chester 
County Quarries, "where it is required to 
be obtained," was in not large enough 
supply. Patience was needed, for by 1840 
the Retreat was still under construction 
and had cost $80,000. 

The estate to create the Preston Retreat 
came in part from the sale of lands of St. 
John's Church in Norristown, Pennsyl- 
vania, and from other securities. Most of 
jthe stock was in the Schuylkill Navigation 
Company which failed in the 1840's. Be- 
cause of the ensuing lack of funds, the Re- 
treat was not finished nor opened until 
1865. In January of 1865 the Board of 
Managers sold 25,000 shares of stock in the 
Schuylkill Navigation Company at $1.00 
iper share, netting $25,000. Jay Cooke and 
Company at this time also purchased the 
Schuylkill Navigation Company lands at 
la cost of $290,000. With this money, the 
Board of Managers then repaired and 
furnished the Preston Retreat in 1865 at a 
cost of $361,734 and opened it for business. 

In October 1865, the Board of Managers 
appointed Dr. William Goodell (7-10) of 
West Chester, Pennsylvania, the first resi- 
dent director and steward of the Preston 
Retreat, with his wife, Caroline Darlington 
Bell (of West Chester, Pennsylvania) acting 
in the position of Matron of the Institution. 

In the spring of 1866, Mr. William 
Saunders, of Washington, D.C., planned 
the ornamentation of the grounds of the 
Preston Retreat. 

Under the mastership of William Good- 
ell, the Preston Retreat flourished and be- 
came a showcase throughout the country 
for the public practice of midwifery. 



Goodell very ably implemented the recom- 
mendations made in the exhaustive Meigs 
report and even enlarged upon it. Under his 
mastership, he supervised the delivery of 
2444 women. 

In August of 1874 he reported on his 
stewardship of the Preston in the Obstetric 
Journal of Great Britain and Ireland. He 
reported on his first 756 deliveries. He had 
had six deaths during this period for an 
incidence of one death for every 126 de- 
liveries. The deaths were: two from sepsis, 
one from a ruptured pelvic abscess, one from 
hemorrhage, one from acute chorea, and one 
from caries of the petrous portion of the 
temporal bone. Thus, his mortality from 
the dreaded puerperal infection or "child 
bed fever" was one in every 378 deliveries, 
far exceeding the record of the famed 
Dublin Lying-in Hospital. 

Goodell was able to achieve this then 
outstanding record in the public practice 
of midwifery by the implementation of the 
Meigs' report and by his own innovations: 
early ambulation of the post partum 
mothers, the avoidance of the routine post 
partum enema, and scrupulous adherence 
to an aseptic technique, with the insistence 
on adequate ventilation in the wards at all 
times. He prohibited the performance of 
any autopsies by himself or his colleagues. 
He advocated immediate postpartum 
breast-feeding and forbade the use of the 
then routine belly band on the infant. He 
insisted that the nurses change their outer 
clothing and wash their hands thoroughly 
when leaving one ward and entering an- 
other. He rotated the postpartum wards, 
and when a ward was emptied, it was 
washed from top to bottom and aired and 
left vacant for two to three weeks. In labor, 
he introduced the administration of a tea- 
spoon of ergot when the baby's head 
pressed on the mother's perineum. When 
the mother entered the second stage of 
labor and if the delivery did not shortly 
ensue, he effected delivery with the vectis 
or forceps to prevent his poor mainour- 



132 



W. ROBERT PENMAN 



ished patients from becoming too fatigued. 
He repaired all perineal lacerations with 
silver wire in order to decrease the pos- 
sibility of infection. When postpartum 
vaginal examinations were indicated, 
Goodell insisted on a thorough scrubbing 
of the hands and then an immersing of the 
fingers in a carbolic acid solution prior to 
the examination. Because of the poor nu- 
tritional state of the patients, they were 
admitted to the Preston one or two weeks 
prior to labor so that they might be 
thoroughly bathed and cleansed and fed 
properly to improve their nutritional and 
physical state so that they could withstand 
the rigors of labor. He obtained the per- 
mission of the Board of Managers to keep 
the women for up to four weeks after de- 
livery in order to bring them back to good 
health before discharge from the Preston. 
In serious and unusual cases, he could, 
with the approval of two thirds of the 
Board of Managers, keep the poor women 
up to twelve weeks. He also had permission 
of the Board of Managers to board the 
children under age seven for the entire 
time while their mothers were confined in 
the Retreat (6). 

At all times, there was a constant de- 
mand for wet nurses. Goodell usually had 
about eighteen women willing to be hired 
as wet nurses at all times, for which they 
were paid 6-7 dollars per week (3). 

Thus, through the implementation of 
the Meigs report and under the diligent 
and brilliant mastership of William Good- 
ell, the Preston Retreat was able to create 
a national model for the public practice of 
midwifery and make such an institution 
safe for all women. These innovations led 
the way for the eventual change in the 



method of delivery from all walks and 
categories of life. 

Acknowledgment 

The author is indebted to the Board of Managers 
of the Pennsylvania Hospital for permission to re- 
print entirely their handwritten copy of the Meigs 
Committee Report. Permission to use original ma- 
terial of The College of Physicians was granted by 
Dr. W. B. McDaniel, Curator of the Library His- 
torical Collections. 

REFERENCES 

1. Kelly, H. A., and Burrace, W. L.: American 

Medical Biographies. Baltimore, 1920, p. 938. 

2. Wilson, J. G., and Fiske, J.: Appleton's Cyclo- 

pedia of American Biography. New York, 
1888, Vol. 4, p. 115. 

3. Preston Retreat Papers, Pennsylvania Hospital, 

Philadelphia, Pa. Miss Joyce Cooper, Curator. 
Microfilm, American Philosophical Society, 
Philadelphia, Pa. 

4. Bryan, J.: Report on The State of the Lying-in 

Hospitals in Europe to the Managers of The 
Preston Retreat and to the Obstetrical Com- 
mittee of The College of Physicians. Phila- 
delphia, 1845. 

5. Ruschenbercer, W. S. W.: An Account of the 

Institution and Progress of The College of 
Physicians of Philadelphia during a Hundred 
Years from January, 1787. Wm. J. Dornan, 
Philadelphia, 1887. 

6. Goodell, W.: The Means Employed at The 

Preston Retreat for the Prevention and Treat- 
ment of Puerperal Infection. Obstetric Jour- 
nal of Great Britain and Ireland, American 
Supp., July-Aug. 1874. 

7. Hirst, B. C: In Memoriam, William Goodell, 

m.d. Transactions of the Amer. Gyn. Soc. 20: 
539-17, 1895. 

8. Parrish, T.: In Memoriam, William Goodell, 

m.d., ll.d., Amer. J. Obstetrics, Vol. XXX: 
827-37, 1894. 

9. Kelly, H. A., and Burrace, W. L.: American 

Medical Biographies. Baltimore, 1920, p. 448. 
10. Wilson, J. G., and Fiske, J.: Appleton's Cyclo- 
pedia of American Biography. Vol. 2, p. 679. 



Notes on the History of Medicine in Hungary 1 



By GE< >RGE P< >L( . \K, m i. 



A YOUNG lad) . born in Budapesl . 
w ho in. it i icd .in \im i. ill. in. latei 
made .i nip around i lie world with 
ho Famil) .mil published ,i travelog, which 
became a bestseller. The siory was pre- 
sented as il told l>\ the lady's little sun. 
ll started as lollows: "My lather is a law 
professor; m\ mothet is Hungarian." 

Ii Minis thai being Hungarian is a 
profession; our is assumed able t<> write 
anil talk about a variet) i>l suhjccls with 
the finesse of an expert. And so I was 
invited id give this lecture mi medical 
history. 

As a visual aid. I brought along a print 
ol an oil painting l>\ an unknown mastei ol 
the earl) 18th Century. I he original was 
found in an old pharmacy in Koszeg, a 
town in Western Hungary. The picture 
shows Cosmas and Daniian, the patron 
saints ol physicians and pharmac isis | Figure 
!)• 

While preparing lor the talk. I (lis- 
covered with regret thai I am old enough 
in remember some ol the events which can 
he considered medical history. The first 
was the coincidence thai m\ professor ol 
biochemistry in m) freshman year at the 
medical school ol Szeged was Albeit 
Szent-Gyorgyi, who won the first Nobel 
prize for his country that very year. We 
gave him serenades and we celebrated a 
lot. hut we had fewer lectures than usual. 
We were proud ol him, and so were the 
people of Szeged, the center of the Hun- 
garian paprika industry. The professor, ol 
course, found a large concentration ol 
vitamin C in that plant, lie also influenced 

1 Set t ion on Medical History, The College of 
Physicians of Philadelphia. II Kelmiarv 1'tfiO. 

- Associate Professor of Pediatries and Physiology . 
Department of Physiology, Division of Graduate 
Medicine. The School of Medicine, University of 
Pennsylvania, Phildaelphia, Pennsylvania 19104. 



medical history in anothei way. Szent- 
Gyorgyi helped great 1\ lo establish the liisi 
democratic student oigani/alion in I inn 
gary, which altei many decades ol still 
Germanic discipline created a Ireei almos- 
phci e ol si udent lai nil \ relal ionsh ip. 

History became darker every year dur- 
ing in\ medical school period, rhere was 
increasing political pressure, discrimina- 
tion, bookburning, and finally war, con- 
centration camps and bombings. Physi- 
cians weie not spared, and I losl many 
good friends dining t hose tragh years. The 

end came with a six week siege ol the 
capital reminiscent ol the Imkish inva- 
sion ol the 16th Century. These were haul 
linns loi everyone, and physicians worked 
heroically amid falling bombs, famine and 

epidemic s. 

Allei the wai there was a glimpse ol hope 
lot freedom, and we weie lull ol optimism. 
I was a Inst year resident when il was m\ 
dut) to appeal icgulaib ai the head- 
quarters ol the American Military Com- 
mission to pick up the penicillin shipments 
donated lo my hospital. It was a wondei 
chug, and we loved the Americans foi 
it. 

Soon new clouds gathered, new disciinii- 
nations and new pressures, purges and 
counterpurges, cultural deprivation and 
diminishing freedom. Medicine again 
shared in all this: therapeutic measures 

for diseases weie ordered by law, educa- 
tion was tightly controlled, and the prac- 
tice ol medicine was reduced to assembly- 
line work. The predictable reaction came 
with the 1956 revolution, followed b) de- 
feat in the lace ol overwhelming forces, and 
mass exodus. I participated again, in a 
small way, in history, when I left tn\ 
country with 7()() othei physicians (nearly 
a 7% loss of medical manpower). This 



133 



134 



(,I-.()R(,I I'OK.AK 




In,. I. Cosmas and Damian. I'aiiiicd l)\ Kndic 
S/as/, after a picture from the 18th Century. 

was a grave (jiiesl ion ol conscience and 
mu( h ol it is not settled to the vei y day. 

You can see from the events of this rela- 
tively shorl period that ihc history ol 
medicine as well as the hision ol an\ 
art or science in Hungai\ is inl imately re- 
lated to the political history of the coun- 
try. This is one of the reasons why for- 
eigners, who did not have the personal 
experience ol being a Hungarian, have 
trouble understanding Hungarian litera- 
ture, poetry, music, etc. 1 will try to il- 
lustrate this close relationship of medical 
and political history in what follows. 

The Magyars occupied the Carpathian 
basin in 895 a.d. During the first fOO years 
they led campaigns against the West and 
got as far as France, but they were even- 
tually driven back and forced to settle 
within the natural boundaries of Hungary. 
The consolidation was helped greatly by 
a remarkable ruler, the first king, Stephen 
I (later Saint Stephen). He not only con- 
verted his people to Christianity in a 



shorl period of time, but established a 
nation on the basis of impressively broadi 
minded principles. "Cuius linguae, uni us- 
que maris regnum imbecille et fragile est," 
said Stephen, and lie could have been a 
founding lather of America for his views 
on the strength ol the multilingual state. 
Alas, his teachings have been forgotten too 
often dining the following 1000 years. 

The Inst dynasty ruled Hungary for 
about 300 years, dining which there was 
productive consolidation of the country 
with some expansive tendencies, leading to 
the earh acceptance of an English-style 
Magna Charta in 1222, but brutally in] 
terrupted by the devastating Tartar inva- 
sion ol 1211 12. Dining the slow recovery, 
iIk ILrpad dynast) came to an end and 
foreign rulers look over the throne. Fifty 
years later there came an imperialistic 
drive for expansion, marred by I lie 
troubles that must be expected with such 
policies, yet bringing some true renais- 
sance- in the ai ts and sciences. 

At the end of the 15th Century, the 
Turkish attackers started threatening the 
southern borders, and by 1526 a new 
tragedy was complete. The nation fell 
apart under the devastating sweep of the 
Turkish armies. The mid- and southern 
pot lions were under Turkish occupation 
Idi mote than 150 years; the northwestern 
pari was a kingdom under Hapsburg rule, 
with sections of the people collaborating 
with and others rebelling against Austria; 
Transylvania in the East formed an inde- 
pendent principality which collaborated to 
some degree with the Turks, but was 
troubled by Catholic-Protestant religious 
rivalry of the princes. 

When in 1699 the Turks were finally 
driven out, with substantial Austrian help, 
a shambles remained of what was once a 
promising, developing country. The na- 
tion predictably and promptly turned 
against the Hapsburgs, which resulted in 
an eleven-year revolutionary war against 
Austria, led by Prince Rakoczi I. The 



NOTES ON HISTORY OK MEDICINE IN HUNGARY 



135 



reaction was that absolutism was intensi- 
fied, inflamed also by the fear of liberal 
winds blowing from Paris after the French 
Revolution. The vicious circle of oppres- 
sion and national-liberal tendencies culmi- 
nated in another bloody uprising in 
1848-49, which again ended in a now even 
more painful defeat. It took eighteen years 
before the wounds were healed sufficiently 
to result in a compromise leading to a few 
decades of ill-at-ease prosperity and tran- 
quillity. Some called this time "the golden 
age." However, the morale of the country 
was weak; with the teachings of Saint 
Stephen all but forgotten, the nation fell 
prey to the intrigues of the Viennese court 
that tried to rule by turning the nation- 
alities in the Carpathian basin against one 
another. The internal strife was to be one 
of the causes of World War I, and the re- 
action to that was in turn to lead to the 
second cataclysm. 

The Medical Profession 

The history of the medical profession in 
Hungary started with the Benedictine 
fathers brought in from Monte Cassino by 
King Stephen. They built their first 
monasteries and primitive hospitals nearby 
in the eleventh century. Some of the ruins 
of these are still present. 

Monks were generally regarded as au- 
thorities in medicine at that time. How- 
ever, they soon became detached and with- 
drawn into theoretical work in their cells, 
and they let their helpers do the unpleas- 
ant part of medicine. Thus, the jobs of the 
surgeon-barbers, executioners, and other 
lay medics came into being. The Tartar 
and Turkish invasions wiped out many of 
the inhabitants of the monasteries, and 
therefore less and less learned people re- 
mained. 

Initial attempts to start higher educa- 
tion in the country were also shattered, 
and young men who wanted to study medi- 
cine had to go abroad. For centuries the 
schools in Bologna and Padova, Halle and 



Heidelberg, Zurich, Leiden, Oxford and 
mainly Vienna saw scores of Hungarian 
students, poor and with the awkward 
habits of their strange country. Noblemen 
did not regard medicine as a desirable 
profession for their sons, but they were 
willing to support poor students in their 
travels. Later, funds were provided by 
some of the European universities, particu- 
larly when, after the Reformation, Prot- 
estants were not allowed into the places of 
higher education in the country. Many of 
these students remained abroad after 
graduation, and Hungarian names were to 
be found among the distinguished teachers 
of many European schools. 

After the Turkish occupation, the trend 
reversed to some extent. The country was 
in poor shape, its population severely 
decimated. Even the Hapsburg rulers, 
probably not without political aims, trans- 
ferred various nationalities from other 
parts of their Empire to Hungary. Many 
brought medical skills, for example, the 
Mennonites, who later were converted to 
Catholicism and who had many accom- 
plished physicians among them. The influx 
did not produce a high level medical pro- 
fession; it rather helped spread the various 
forms of charlatanism. There were the 
liniment and oil peddlers from the Slavic 
regions, the herniotomes and lithotomes, 
the occultists and the real witch doctors. 
Laws were signed against charlatans as 
early as the end of the 16th Century, but 
they were not very effective. 

It Was just before the great plague and 
small pox epidemics of the 18th Century 
that Queen Maria Theresa established the 
first formal medical faculty at the Univer- 
sity of Nagyszombat (Tirnau) in western 
Hungary. At the opening of the school in 
1770, five chairs were filled by German- 
speaking Austrians. Protestants were not 
admitted and neither were Jews (in Hun- 
gary, where the rights of Jewish merchants 
were assured by law more than 500 years 
before this time). The graduates were not 



136 



GEORGE roi.GAR 



licensed in the monarchy as a whole, only 
in the Hungarian territories. This, and the 
poor financial state of the school in its 
first decades of existence, discouraged 
many young men from enrolling. At the 
same time, classes at the Vienna school 
were overflowing with Hungarians, which 
again worried some Austrians. But these 
were the troubled times between the revo- 
lutionary wars of Rak6czi and the 1848 
rebellion. Hungarians could not expect 
much help from their rulers. No medical 
journal was permitted to appear in Hun- 
gary, not even in Latin. 

The first medical faculty moved to 
Buda in 1778 with a three-year course, and 
opened a five-year curriculum only after 
1805. There was a little known partial 
school in Transylvania, but more com- 
plete medical faculties were not estab- 
lished until around the turn of the cen- 
tury. 

The school in Buda and later the one in 
Pest saw little excitement. Student disci- 
pline was a lesser problem than nowadays, 
but, ironically, at one time the students 
had to be ordered by the university au- 
thorities not to wear short hair, because it 
was against good taste when everybody 
wore it long. There was a brief open re- 
bellion when, during the cholera epidemic 
of 1831, the town was under quarantine 
and the students wanted to break out and 
go home to their families. 

Public Health 

The state of public health was under- 
standably linked to the political events. In 
times of war and occupation even mem- 
bers of the highest nobility became louse- 
infested, and various epidemics helped the 
occupiers decimate the population. How- 
ever, the Magyars were relatively clean 
people, who liked bathing more than their 
neighbors. The numerous spas and hot 
springs which were and still are to be 
found in various parts of the country 
presumably contributed to their enjoy- 



ment of bathing. Just as profoundly as the 
Turkish invasion affected the fauna, flora, 
and even the climate of the occupied parts 
of the country, the ritual bathing habits of 
the Turks were also instilled in the people. 
Several of the original Turkish baths still 
stand as historic monuments, and some are 
even used. 

The native population learned the hard 
way to protect itself from the endemic dis- 
eases spread by polluted waters and other 
uncontrolled environmental factors. Wine- 
drinking became universal when, during 
the occupation, wells and creeks became 
unreliable. Wine was probably the one 
thing in which the Turks were not inter- 
ested, since their religion prohibited its 
consumption. It is a fact that immigrants 
and visitors, unfamiliar with the local con- 
ditions, fell victim to the endemic typhoid, 
dysentery, etc., in larger proportions than 
native Hungarians. Other major diseases 
afflicting the people of the middle ages, 
such as syphilis, lepra, tuberculosis, and 
the great epidemics of plague and cholera 
knew no national barriers and severely 
limited the chances for quick recuperation 
from the grave losses suffered by the politi- 
cal events. 

Learned physicians being as rare as they 
were during the centuries before formal 
medical education began, the people con- 
sulted charlatans and relied on collections 
of home-made remedies and proverbial 
health advice for their complaints. Al- 
manacs, published yearly and being the 
only printed reading material next to the 
Bible for most country people, contained a 
wealth of popular medicine. For example, 
the "Locsei Kalendarium" (Calandar of 
Locse) of 1626 offers the following advice 3 
for the first two months of the year: 

January: 

Don't suffer from bloodlett'n' 
In the month of the Virgin, 

Spice all the food you put away, 
You will live to see many a day. 

3 Translated by Steven Polgar. 



NOTKS ON IIIMOIO ( >l MM»I< l\l l\ III \(.\K\ 



137 



l ( hi u.ii \ : 

Protect yoursell From the cold, 
Don'l eal Bsh, drink wine that's old, 
li won't linn you to take a bath, 
Don'l 1 1 . 1 1 M i v oui Ik><!\ , sit i<> 1 1 1 .i i 

foculai references to the various effects 
ol the diet, Mich as the Eollowing, were 
( ommonh i < >li I ovei meals: 

fresh cabbage squeezes; cook its juice, that softens: 
Eat one after the other, your stoinac li'll empi\ 
faster. 

The- teller ol litis ban /not was allegcdh 
repi iniaiided l)\ the hostess at ,i nobleman's 
dinner table, because ii was considered un- 
worth) ol high society conversation. 

Ol course, serious monographs also were 
written about various diseases. "A Short 
Meditation on the Plague" In Mate 
Csanaki (1634), a court physician, gives a 
Father accurate symptomatology ol the 
dreaded disease. The etiology as com- 
monh accepted was "Cod's scourge for 
punishment of our sins.'' Suggested treat- 
ment: venesection, purgation, plasters, 
and mainly the consumption of garlic. I he 
latter was indeed used excessiveh In rich 
and poor alike. 

Cholera had its own literature in pro- 
fessional as well as in line prose and 
poetry. Particularly infamous was the last 
big epidemic of 1S31. which triggered an 
uprising of the peasants against the land- 
lords, who were allegedly responsible for 
the epidemic. The stor\ was spread inten- 
tionally by political profit-seekers. 

An interesting pamphlet about pipe- 
smoking appeared in 1762. It gives a gen- 
erally favorable opinion aboul the effects 
oJ smoking, particularly in the morning 
hours, when it supposedly clears the throat 
and stimulates gastric function: but. some 
warning is also voiced against its use to- 
gether with excessive drinking, in which 
case it may be deleterious to the lun»s and 
tna\ even cause "dry cough" (tuberculosis). 
It shows a remarkable degree ol loresighi 
200 years before our Surgeon General's first 
report on smoking. 



Finally, toward the mid- 19th Century, 
bettei medical education and medical care 
began to make theii effects Eelt. Even the 
almanacs were mote reasonable. In tli< 
1841 edition, a mocker) ol the old-fash 
ioned superstitious home remedies appears: 

For tooth-ache take a birds' egg with some water 
in your mouth; sit on the stove until the egg be- 
comes soli boiled; you will never have a tooth-ache 
again, 

Hungarian medicine was not entirely 
unknown abroad even long before the lust 
Nobel 1'ii/e winner. Paracelsus traveled 
extensiveh in Hungar\ in the I ")20's si ud\ - 
ing medical practices, and, as a secondary 
projet i . wines, rhe m< »si famous panat ea 
ol 18th Centur) Europe was Aqua Regina 
Hungaricae, a simple alcoholic extract ol 
rosemary (spit it us rosmarini). The drug 
was used l>\ the uppei (lasses (including 
such notables as Louis XIV and Mine, de 
SeVign£) for almost everything. It is difli- 
culi to say what the secrel ol good pub- 
lic ii\ is in sue h matters! 

Important Figures 

Finally, let me introduce a few ol the 
historic figures of Hungarian medicine: 

Agoston (Augustin) S( liopf-Merey was 
the foundei ol the first pediatric hospital 
in Budapest (1838). He also taught medical 
history. Like main of his colleagues, he 
participated in the IX1S-1!) revolution and 
went into exile alter its defeat. He started 
a hospital for sick children in Manchester, 
England, with a native obstetrician named 
Whitehead. 

Jdnos (John) Bdkai, Sr. was born in 1822 
ol German-speaking parents (his original 
name was Bock). He took over Schopf- 
Merey's hospital in IS 17 and became the 
first professor and chairman of a pediatric 
department in a medical school in the 
whole of Europe. Bokai died from injuries 
suffered in a fall while opening his new- 
Hospital for Poor Children. He founded a 
pediatric dynasty. Two ol his descendents 



GEORGF POLGAR 




Fic. 2. Janos Bokai, Sr. 




Fk.. Frigyes Koranyi. 

(Janos, Jr. and Zoltan) became professors 
oi the new discipline. 

Frigyes (Frederick) Koranyi (1828-1913) 
was founder of modern internal medicine 
in Hungary and started the long fight 
against tuberculosis. He designed a steth- 




Fic. 4. Janos Balassa. 

oscope, which was widely used by inter- 
nists, hut not In pediatricians. He also 
started a dynasty: his son Sanrior and 
several relatives became leading figures in 
internal medicine. 

Jdnos (jolni) Balassa was one of the 
greatest surgeons of his time. He obtained 
numerous invitations to chairs in foreign 
schools, but he was an ardent Hungarian 
and stayed home. He had a leading role in 
the 1848 revolution and was jailed after- 
wards, because of his name in surgery 
the king pardoned him and he was given 
his position again. This was the more re- 
markable, because Balassa was the son of a 
Protestant minister, an almost guaranteed 
reason for exclusion from high posts. 

Lajos (Louis) Markusovszky (1834-93), 
also an eminent surgeon and Balassa's 
disciple, was not so luck). He never be- 
came professor because of his religion. He 
was founder and long-time editor of the 
(nst and still existing medical journal 
(Orvosi Hetilap). 



NOTES ON HISTORY OI Ml DM i\i i\ in NGARY 



139 




Fig. 5. Lajos Markusovszky. 

Ii seems to me thai I should nol mention 
Ignaz Scnnnchvcis (1818-1865) al all, be- 
cause lie and his Hungarian origin are so 
will known. Vet, when leading his stor\ 
again the other day. it struck me that the 
drama ol this genius is more than the life 
ol an individual. This man. who, with the 
spontaneity of a Newton, discovered the 
relationship between contamination by de- 
caying human remains Erom the autopsy 
table and the dreaded mass murderer, 
puerperal lever, and who stayed with his 
interpretation of this discovery al a time 
when Virchow's cellulai pathology theorj 
was at its zenith, fought lor his idea and 
•<>> die life ol thousands of mothers with 
fihe heroism ol all the Hungarian rebels 
throughout the centuries. He was as sure 
about the truth of his discovery as was 
Galileo and (like that other genius) he was 
diiu'ii to extremes, with the difference that 
Senunelweis was fighting not onl\ loi an 
idea hut lor 1 ives. He was (uiall\ declared 
paranoid, which under the circumstances 
was a reasonable conclusion, and com- 




Fig. 6. Ignaz Semmelweis. 



mined to ,m asylum. Several weeks latei he 
died, ironically, from a wound infection 
which he contracted during an operation 
before his detention. His life was the 
Hungarian tragedy: a spirit warning the 
world, not heard, crying for help, not as- 
sisted. He was also ,i true medical genius, 
who preceded Pasteui In ihim years and 
Lister b\ about twenty, with the new idea 
ol infectious etiolog) ol diseases. I lis op- 
ponents destroyed much ol their credii l>\ 
closing theii ears ami eyes Erom the truth. 

REFERENCES 

II \ i \- s \ . l-.: A Kossuth-idok Hazafias Orvosai. Kar- 

pathia Kiad6, Munich, 1954. 
Macyary-Kossa, J. V.: Ungarische Medizinische 

Erinnerungen. Danubia, Budapest, 193"). 
TrocsAnyi, A.: Rigi Vildg, Furcsa Vildg. Bibli- 

otheca, Budapest, 1958. 
Homan, F. wn SzEKFUj C.Y.: Magyar Tortenet. Ki- 

ralyi Magyar Egyctemi Nvomda, Budapest, 

1935. 



Medicine, Music and Academia 

By V. WILLIAM SUNDERMAN, m.d., ph.d.,sc.d. j 



BECAUSE ol in\ persona] associations 
in medi< inc. music and universities, 
il seemed appropiiate to lo< t is the 
remarks tin's evening upon ilnce aieas ol 
intciest. I hope that these areas might hold 
some appeal to you. 

Tirst, reference will he made to the con- 
tributions to music by three eminent 
physicians who lived during the past ccn- 
tury. The second area will be directed to 
the furtherance ol music through the 
friendship ol Billroth and Brahms. Bill- 
roth was one ol the woild's greatest sur- 
geons. ,iud lira Inns was one ol the world's 
greatest composers ol music. And, lastly, 
a resume ol Brahms' Academic Festival 
Overture will he given in older to capture 
the spiiii ol the European universities 
about a hundred years ago. 

Contributions of Physicians 
to Music 

The ait of music and the priesthood of 
medicine have been closely linked since 
ancient limes. All of you know that Apollo 
was the god of medicine, hut how many 
know that he was also the god ol music? 
The noblest conception within the range 
ol Greek mythology places Phoebus-Apollo 
as the god of both medicine and music. 
Although music and medicine have been 
closely related for thousands of years, never- 
theless, at no time was the association more 
intimate than dining the latter part of the 
past century in the European universities. 

In assessing the . development of music 
during the past century, mention should 
be made of the outstanding contributions 
of three physicians, all of whom were con- 
temporaries covering the period of 1821 to 

1 Section on Medical History, The College of 
Physicians of Philadelphia, 11 February 1969. 

Director, Institute for Clinical Science, Inc., 
1930 Chestnut Street, Philadelphia, Pa. 19103. 



18!) I, all of whom were professors in medi- 
cal colleges ol European universities, and 
all ol whom were dedicated to the further- 
ance of music. These three physicians were 
Helmholtz, Borodin and Billroth. 

1 he In si physician to whom tribute 
should be paid was Hermann von Helni- 
hoh/ (1821-94) (Figure 1). Helmholtz 
possessed one of the greatest scientific 
minds of the nineteenth century and held 
professorships in the medical colleges of 
the Universities of Kdnigsburg, Bonn, 
Heidelberg, and Berlin. W hile at the Uni- 
versity of Kdnigsburg, he published his 
monumental work entitled, The Sensa- 
tions of Tone as the Physiological Basis of 
Music. This book has been translated into 
many languages and is still fittingly re- 
ferred to as the "Principia ol Acoustics." 

The second Aesculapian to whom honor 
should be given was the great Russian 
biochemist and professor in the Medical 
College at the University of St. Petersburg 
during the past century. Alexander Por- 
firivich Borodin (1833-87) was the illegiti- 
mate son of one of the Russian princes 
(Figure 2). The name, "Borodin," was the 
mii name of one of his father's slaves. (One 
should, perhaps, realize that illegitimacy 
does not preclude one from attaining high 
honors in either music or medicine.) Al- 
though Borodin was a distinguished scien- 
tist, his claim to immortality arises chiefly 
b om his accomplishments as a musical com- 
poser which he himself regarded "as a 
recreation, a past-time, and an avocation 
that distracts me from my principal activity 
as a professor." Borodin founded the famous 
Russian Kouchka (Circle of Five) 3 whose 
members openly revolted against the rules 
and conventions of European music, feeling 

3 The members of the Kouchka were Mous- 
sorgsky, Rimsky-Korsakoff, Cesar Cui, BalakireS 
and Borodin. 



140 



MEDH I N I \l I SI< 

thai i lie 1 1 .ul n ional i lassii .1 1 music inhibited 
the free expression oJ Russian musical 
thought and feeling. Borodin did not leave 
a greal numbei ol compositions; whal he 
did leave has weight and commands re- 
spect. Ii was the . 1 1 1 1 1 < >s 1 mi 1 .11 u li ins good 
fortune foi yom speakei five years . 1 < > i<> 
have rediscovered in Moscow i>\ sheer 
happenstance Borodin's string sextet which 
had been l<>si since its initial performance 
i n I [eidell »ei g in 1 863. 

I'hc third disciple ol I Iippoc rales de- 
serving ol special tribute is lheodoi 1 > i 1 1 
FOth ( 1829 94) (Figure .">). who was destined 
to become one ol die outstanding leadeis 
ol his cent in \ In the development ol both ol 
the fields of medicine and music. Unlike 
Helmholtz, whose musical contributions 
Were direc ted mainh to sc ientific considera- 
tions, oi to Borodin, the talented compose] 
of music, Billroth w as both a physician and 




Fie. I. Hermann von Helmholtz (1821-94). 



VND ACADEMIA III 




t ic 2. Mexaiulcr Porfirivich Borodin (1833-87). 



a musician whose musical contributions 
were mainly those ol a philosopher, edu- 
cator, mentor and patron of the art. 

Most physicians are well aware of Bill- 
roth's contributions to the medical sci- 
ences. His book on Surgical Pathology 
(Allegcmci tic Chirurgische Pathologic mid 
TIi era pic) is still regarded as one of the 
finest treatises in medical literature, evi- 
denced In the lac t that it has been trans- 
lated into nine languages (and even into 
Japanese). Of Billroth's boundless energy, 
originality and foresight in surgery, every 
surgical amphitheater in the world offers 
ample proof. However, the fact that he 
was a proved musician, that he wrote a 
book on the physiology of music (Wcr 1st 
Musikalish), that he exerted a dominant 
influence on the music of his period — and 



I V2 



I. \\ II I.IAM SIM)! KM \\ 




I k.. .!. I heodoi Billroth (1829-94). 



especially the music of Brahms — is less 
well known, urn onh In physicians, bui 
also by musicians. But, ihis is a fact. 4 

Bn.i ROTH \M) Br \ll\ls 

litis brings us lo the second area of 
interesi . the music al 1 1 iendship bei ween 
Billroth and Bi ahms. 

During the earl) pan ol the last cen- 
tury, two boys were born in northern 
Germany about 125 miles apart. One boy 
was born in 1SL'!I into a gracious, cultured 
home on the enchanting island of Rugen 
in the Baltic. He was the son ol a Lutheran 
preacher and a descendant of four genera- 
tions of distinguished scholars, artists and 
musicians. The other boy was born four 

4 Brahms composed three string quartets, two of 
which he dedicated to Billroth. These quartets 
are frequently played in my home. Upon reading 
the dedication to Billroth on the title page of the 
Opus 51 quartets, it is surprising how often ac- 
complished musicians will ask, "Who was this 
fellow, Billroth, anyway?" 



years laici in 1833 into the uncultured 
environment of the slum distiiei ol Ham- 
burg. He was the son ol a pool, destitute '• 
musician, and his family filled a compara- 
tively lowly position in life. The first boy 
became one of the world's greatest surgeons 
whose surgical operations with minor 
modifications are still used in almost every 
hospital in the world; the second boy be- I 
came one ol the world's greatest composers I 
ol music whose music is heard in practi- 
cally every concert hall. The fust boy's 
name was Theodor Billroth; the second 
boy's name was Johannes Brahms. 

Theodor Billroth was gifted in music 
lioin his early youth. His maternal grand- 
parents had been professional opera sing- I 
ers, and through them, he became familiar 
with the compositions of the great masters. I 
During his \outh, he- developed into an 
excellent pianist. At the age ol nineteen, 
at the recpiest of his family, Billroth gave 
up the pursuit ol music as a career and 
began the study of medicine at the Uni- 
versity ol Goitingcn. Although he was a 
student of medicine, nevertheless, at 
Gdttingen he continued to keep up his 
musical interesi and. on occasion, served 1 
as the accompanist Eoi Jenny Lind and 
other artists. 

Compared to the early career of Bill- 
roth, that of Brahms was epiite dissimilar. 1 
In Brahms' early youth, two interested 1 
music teachers recognized the highly < 
gifted talents of Brahms and furthered his i 
musical education, in spite of his lack of 
facilities and financial support. He at- 
tended grade school and educated himself | 
for the most part by voracious reading f 
and diligent study. As a means of liveli- 
hood, he played dance music for the sail- 
ors and their girl friends in the brothels 
along the waterfronts of Hamburg. At the I 
age of nineteen, he left Hamburg on a 
concert tour as the piano accompanist to 
the well-known Hungarian gypsy violinist. 
Remenyi. In the course of this tour, he had 



MEDICINE, MUSH Wli \c 



Ml \ 



die good loiiune i eel Robert Schu 

I mann, the composer, w ho proclaimed 
Brahms io be ihc coming musical genius 
ol Germany. Aftei concert izing extensiveh 
lias a pianist, Brahms accepted the position 
.in Directoi i>i the School ol Musi* in Det- 
mold. Ii was while holding this posl thai 
Brahms composed some ol his fines) cham 
music. 

1 am happy to have visited Detmold on 
a number uf occasions, and while there, I 
have alwa\s reserved Room 5 in the Hold 
Stadt l i.inklui i where Brahms lived from 
J 1857-55). Indeed. I hd a certain gratitude 

that some ol m\ own ancestors eni.in.iied 

t Ins i i( hl\ ( nil in ,,| area. When I v isil 
I Detmold, ii also gives me pleasure to 
wander along die path through the I euten- 
berger Mountain to the Hermann monu- 
" K '"i 'ii « t .s summit. Ii was along this path 
dial Brahms is said to have obtained the 
inspiralioii lor a numbei ol his most beauti- 
' Eul melodies. In spile ol his prolific writings, 
• ii no lime did Brahms evei pain a Iivine 

I f 1 o 

from the sale of musical compositions. He 
I sustained himseli almosl entirely by con- 
' ducting orchestras and < hoirs and Erom ap- 
pearances as a concert pianist. 

After his Detmold days, Brahms returned 
to his home town ol I Eamburg and, deep 
"i his heart, craved to be appointed the 
conductor ol the Hamburg orchestra. 
When this position, however, Eel] to an- 
other, Brahms lefi Hamburg and settled 
m Vienna, a city comfortably administered 
by the Hapsburgs and glowing with the 
warmth of musical tradition. 

Several years prior to the time thai 
Brahms removed to Vienna, Billroth had 
accepted the professorship ol surgery at the 
University of Zurich (1858). While at 
Zurich, Billroth developed an aversion 
for Wagner's music: however, the music ol 
Brahms appealed to him. Thus, it was 
with genuine' delighi thai Billroth met 
Brahms, probably for the first time, in 
Zurich when the latter was on a concert 




I n,. I. Johannes Biahms ( IH.'i.'i ( I7). 

tour. 5 I he accouni ol Brahms' reception 

h\ Billroth is molded in one ol Brahms' 
lei lei s to ( Mat a Schumann : 

You ma\ he able l<> gathei how will I was received 
from the fact that aftei m\ Inst concert in Zurich,., 
one ol two nmsii.il friends ... arranged a private 
concert on Sunday.... They hired the orchestra 
and telegraphed far and wide lor tin musical 

scores \n\bod\ who had any interest in music 

was invited to listen without further ado. 

In 1867, when Billroth was offered the 
Professorship ol Surgery at the University 
"I Vienna, he readily accepted. The ac- 
ceptance was probably made more gladly 

since his friend Brahms had already ved 

to Vienna the previous year. He and 
Brahms had found much in common in 
Vienna. Both were North German Protes- 
tants transplanted to a foreign soil which 
was predominantly Catholic, and both 

A photograph of Brahms is shown in Figure 4. 
Actually, Billroth and Brahms resembled each other 
and were often mistaken for brothers. 



1 1 1 



I WILLIAM si \DI R.MAN 



maintained .1 strong patriotism which the 
war of helped to intensify. After 

the Insi three months in Vienna, Billroth 
wrote to one ol Ins friends that, within 
two months, he had attended nineteen 
concerts, had seldom gone to bed before 
two o'clock in the morning, and thai he, 
Brahms and Hanslick (the tnusit critii 
who was also Professor of Music at the 
University) had met several limes a week 
to attend a concert, go to the theatre, or 
simph to dine together. Billroth became 
enraptured with the musical and .niisiu 
life of Vienna, bm fell thai in science he 
missed the strict German discipline to 
which he had been accustomed. In Bill- 
roth's words, "Science requires a firm and 
hard ground rather than a rich, warm soil." 

In Vienna, Billroth s home was simple 
in design, with the exception ol the music 
room, which was ornate. At the innumer- 
able concerts given at his home, Bilhoth 
was always the centei ol attraction. The 
audience seemed to be inspired by his 
striking image, his bncnanl spirit, his 
glowing love of life, and his joy in making 
music. 

Practically all of the chamber music 
composed by Brahms after 1867 was played 
lor the first time before a selected audi- 
ence in Billroth's home. Hanslick hu- 
moroush remarked thai Billroth had "Jus 
prirnac noctis." Throughout the ensuing 
years, the new compositions of Brahms 
were given to Billroth in manuscript form 
for his comments. This was a flattering 
acknowledgment of the confidence which 
Brahms placed in Billroth's musical judg- 
ment. 

The evening activities in Billroth's home 
were essentially of two types: those at 
which string quartets and the leading 
artists of Europe would perform informally 
before a small group and those before a 
larger group at which a formal concert 
would be given and Brahms would con- 
duct. The guests for these occasions were 



proposed by Billroth, bin no invitations 
were extended without Brahms' approval. 
After the performance, there was no diffi- 
culty in ascertaining Billroth's reaction. If 
the artists performed creditably, cham- 
pagne was served with the refreshments; 
il the performance was mediocre, beer was 
provided. (I hope a satisfactory libation 
w ill be merited this evening.) 

In the environment of Vienna and its 
great university, Billroth and Brahms re- 
mained loyal and devoted friends for more 
than a quarter of a century. Although 
Brahms held no academic appointment at 
the University, he became closely affiliated 
with it through his faculty associations and 
his posts as conductor of various musical 
organizations. The publication of 331 
letters between Billroth and Brahms (many 
ol which I have translated) a fiords an 
excellent portrayal ol the cultured en- 
vironmeni ol Vienna and gives an insight 
into the dominant role that these men 
pla\cd in the furtherance of music during 
this past century. 

With advancing years, Bilhoth became 
the idol of the University and the Viennese 
people. All hough Billroth (in a letter to 
Brahms) expressed pleasure ovei his popu- 
larity, nevertheless, in a more critical letter 
to one of his former colleagues in Zurich, 
he wrote, "What do the people really know 
as to my scientific accomplishments? Noth- 
ing. A myth develops: the myth starts 
from something not understood, partly 
horn superstition, and develops into a 
miracle through the imagination of the 
people. I believe that the surgical removal 
of the larynx and replacing it with an arti- 
ficial one G was the beginning of the myth 
about me. The people have a morbid cu- 
riosity and the press knows well how to 
take advantage of it. Now, this would 
all be very entertaining, but I am over- 
whelmed by the profuse admiration. . . . 

,; Billroth was a pioneering surgeon in inserting 
artificial organs. 



MEDICINE, MUSIC AND ACADEMIA 



145 



What I know, my students know also, 
and perhaps even better. ... At my years, 
I can be regarded only as a useful direc- 
tion-pointer — one who can point to the 
right way or at least in the direction to the 
right way." It might be mentioned that 
almost all of the chairs of surgery in the 
leading medical colleges of Europe were 
occupied by Billroth students. 

The dominant passion throughout Bill- 
roth's life was his love of music. He be- 
lieved that the study of music greatly aided 
his ability as a surgeon. Even in his medi- 
cal writings, one senses the interest which 
Billroth had in music and musicians. Thus, 
in discussing methods for selecting men 
who are best fitted for university pro- 
fessorships, he quotes Schumann's maxim, 
"Perhaps only the genius quite under- 
stands the genius." One of the best illus- 
trations of his tendency to write in musical 
terms is a letter written to his old Profes- 
sor Baum, at Gottingen: "The end of your 
letter in which you speak about your age 
in a sad tone does not agree with your 
otherwise youthful attitude. . . . The inspi- 
ration of living lies in the beautiful har- 
monic sequence of our major and minor 
thoughts. You have still plenty of time to 
think of the closing symphony of life as 
it is portrayed by Beethoven in the end of 
"Egmont" and in the "Ode to Joy" in 
Beethoven's Ninth Symphony. May God 
still keep you long as a conductor of the 
orchestra and have patience with one of 
the oldest members in your orchestra who 
is a violinist and is anxious to be ad- 
vanced to the first stand." 

At Billroth's death, the entire city of 
Vienna went into mourning. No ruling 
monarch was ever accorded more reverend 
respect. Brahms commented that, among 
the enormous crowd in attendance at 
the funeral, there was not one indifferent 
or inquisitive face but only expressions of 
deepest sympathy and affection. The stature 
of Billroth, the physician and musician, 



perhaps can best be appreciated by quoting 
a brief portion of the lengthy eulogy 
given by the rector of the University: 

For Thcodor Billroth, the black flag of mourning 
is flying from the roofs of official buildings. It sig- 
nifies the death of a man who was the foremost 
ornament of our faculty. Science has lost one of its 
most genial representatives, an inspiring spirit at 
whom all of us younger men gazed in venera- 
tion. . . . The Vienna Medical School, all of Austria, 
and all of the world mourns this irreplaceable 
loss. . . . When he refused the call to the professor- 
ship of surgery in Berlin, he received from us an 
ovation which was a storm of enthusiam and love. 
His words on that occasion still ring in our ears, 
when he said, 'I cannot conceive that I would 
ever say farewell to Vienna.' Now, we shall have- 
to accustom ourselves to the thought that we have 
lost forever this scholar, this musician, this Sa- 
maritan, this thinker, this poet, and in one word, 
this genius — Thcodor Billroth. 

Academic Festival Overture 

In endeavoring to capture the unique 
spirit of commencement time at the 
European universities during the past cen- 
tury, attention has been directed to the 
University of Vienna in which Billroth, 
Brahms and Hanslick (the Professor of 
Music) dominated the medical and musical 
disciplines. It seems to me that this spirit is 
fittingly expressed in the music of Brahms' 
Academic Festival Overture, parts of which 
I should like to play for you. The Aca- 
demic Festival Overture is mentioned in 
at least one of the letters of Brahms to 
Billroth, and it can be inferred that 
Brahms discussed the material and con- 
struction of this work with his devoted 
friend, Billroth. 

The overture was written in 1880 by 
Brahms as a gesture of thanks to the 
University of Breslau upon the conferment 
of an honorary doctorate degree. Thus, we 
see that this quid pro quo for honors was 
effectively applied in university dealings 
even a hundred years ago. In composing 
the overture, Brahms did not make the 
customary formal approach, but based it 



14G 




Melodie des Landesvaters 
-k- 




Was kommt dort von der hoh (Fuohslied) 













rr~f — f~f1 


H 


5- 


1 — 1 


1— 
































Fic. 5. Songs incorporated in Brahms' Academic Festival Overture. 



upon the point of view of student tradi- 
tion. The work involves the music of 
four time-honored student songs which, 
with the exception of one, were joyously 
sung at graduation and other festive oc- 
casions. 

The first song in the overture, which is 
brilliantly intoned by the trumpets, bears 
the title, "Wir hatten gebauet ein statt- 
liches Haus" ("We Had Built a Stately 
House") (Figure 5). It is said that some of 
the student parodies were slightly ribald 
and would suggest that at least some of the 
houses that were built were not always in 
the character of stately mansions. The 
translation of the first verse is as follows: 

We had built a stately house, 

Inside of which we placed our trust in God, 

In spite of weather, storm, and fear. 



The second student song is the "Landes- 
vater" (the most solemn song to the 
Father of the Country). 7 

The "Landesvater" song (Figure 5) was 
written before 1770 and was used on rare 
occasions of patriotic consecration. A 
sword was passed around among the stu- 
dents in a fraternity and each student 
pierced the sword through his colored 
fraternity cap, singing, "Ich durchbohr den 
Hut und schwore, halten will ich stets auf 
Ehre, stets ein braver Bursche sein." ("I 

7 The full text of this song was obtained through 
the kindness of one of my friends who is a pro- 
fessor at the University of Heidelberg. I might say, 
parenthetically, that in preparing the material for 
this talk, I am in the position of Charles Lamb 
who explained how he wrote one of his essays. 
Said he, "I milked twenty cows to get the milk, 
but the butter I churned is all my own". 



Ml- 1 HUNK. Ml'MC AM) \( Ml \ 



147 



pierce the hat and swear I will always 
insist upon honor and always be a brave 
fellow.") After the ceremony, the stu- 
dent's sweetheart was honored with the 
task of closing the hole in the hat by 
embroidering a silver oak leaf over it as a 
token of participation in a Landesvaler. 

The third song is the "Fuchslied" (Fig- 
ure 5) which literally translated is "Fox 
Song." A "fox" in the German universities 
is an uninitiated freshman fraternity man. 
The song is a rollicking, jolly roundelay 
used in freshman initiation ceremonies. 
In the ceremony, the freshman entered the 
room riding on a heavy leather upholstered 
chair. The rumbling rhythm of this ride 
is well-marked in the instrumentation. 

The melodies of these three songs are 
interwoven in the first part of the over- 
ture. In using folk music, a composer can- 
not move abruptly from one song into 
the next but must employ bridgings. 

(At this time, a tape-recording of that por- 
tion of the overture was played which con- 
tains the three songs.) 

The closing, or fourth, student song 
is the well-known "Gaudeamas Igitnr" 
("Now Let Us Be Joyful"). This was and 
remains the official anthem of the German 
university student. 

In composing the Academic Festival 
Overture, Brahms played the first three 
songs against each other in a most delight- 
ful way, and after a recapitulation of all 
of the material, he had the orchestra 
burst into a highly-spirited jovial version 
of the celebrated "Gaudeamus Igitur" in 
which the students joined wholeheartedly 
in the singing. The translation of the 
fourth verse of "Gaudeamus Igitur" is as 
follows: 

Raise we, then, the joyous shout: 

Life to Alma Mater! 

Raise we, then, the joyous shout: 

Life to Alma Mater! 

Life to each professor here, 

Life to all our comrades dear, 

May they leave us never, 

May they leave us never. 



Brahms liked to refer to the Academic 
Fesitival Overture as his "laughing" or 
"happy" overture. He was criticized for 
pitching the "Gaudeamus Igitur" too 
high. This song is usually sung in either 
the keys of A- or B-flat. In order to achieve 
brilliance, Brahms raised the pitch to the 
key of C. So, excepting for the sopranos 
and tenors, one may find the orchestral 
version a little high for singing. 

For the Academic Festival Overture, 
Brahms employed the largest orchestra he 
had ever used in any of his compositions. 
At the end of the overture, he has every 
player scraping, blowing and hitting as 
hard as he can. Although the intensity of 
the sound on the recording is reduced, 
nevertheless, many may complain that the 
rendition is too loud. All that can be said 
in reply is that it is not as loud as it was 
intended to be. 

(The Philadelphia Physicians String Quar- 
tet played a transcription of each of the four 
songs. A tape-recording of the closing sec- 
tion of the overture was also played.) 

The story of the Academic Festival Over- 
ture could be written entirely around 
Brahms. However, how much of the com- 
position is really Brahms, and how much 
of it is Billroth? Certainly the happy festive 
character of the piece is more in keeping 
with the genial, extroverted personality 
of Billroth. Moreover, Brahms never at- 
tended a university as an undergraduate 
student and obviously had never taken part 
in a student fraternity initiation or in a 
Landesvater ceremony. Therefore, the stu- 
dent songs that were incorporated into the 
overture would not have been as meaning- 
ful to Brahms as to Billroth, who had 
spent his entire life amid academic sur- 
roundings. 

It is a matter of record that Brahms 
discussed the composition with Billroth, 
and undoubtedly, there was an exchange of 
ideas concerning it. The exchange of ideas 
and the mingling of men's thoughts are 
ennobling forces that enrich the intellec- 



148 



F. WILLIAM SUNDERMAN 



tual aura of every college or university 
environment. This exchange provides the 
inspiration for research and creative en- 
deavor, and as a consequence, it oftimes 
becomes difficult (and really unnecessary) 
to give appropriate credit. However, the 
question might reasonably pose itself into 
an inquiring mind: Does the Academic 
Festival Overture emanate mostly from 
Brahms or mostly from Billroth? And then 
the second question should be asked: 
Does it really matter? 

The names of Helmholtz, Borodin, Bill- 



roth and Brahms and their monumental 
works will doubtless live through the 
ages. The last movement of Brahms' Ger- 
man Requiem was based upon a verse 
from Revelations which the Pastor also 
used as the text at Brahms' funeral and 
which I quote: 

Blessed are the dead which die in the Lord for 
henceforth they may rest from their labors and 
their works will follow them. (Rev. 14:13) 

I feel certain that the traditions of our 
College of Physicians encompass this 
thought. 



Distillates from Hieronymus Brunschwig's 
Book of Distillation 

By MARION B. SAVIN, m.s., and HAROLD J. ABRAHAMS, ph.d.i 



THE closing years of the fifteenth cen- 
tury found Hieronymus Brunschwig 
(1440-ca. 1512), surgeon of the Im- 
perial Free City of Strassburg, writing his 
second book: Liber de arte distillandi de simplici- 
bus. Das Buch der rechten Kunst zu distiliren die 
eintzigen Ding. It was published in Strassburg, 
as of May 8, 1500, by the famous house of 
Johannes Griininger, which had, three years 
earlier, brought out Brunschwig's first: 
Buch der Cirurgia. That historians of chemistry 
have, for a long time, shown a deep interest 
in and respect for this work (known as the 
Small Book of Distillation, or Kleines Distil- 
lierbuch) is quite understandable, in the light 
of the fact that, in an era when alchemy was 
still bogged down in its non-productive 
absorption in gold-making, with its literature 
virtually incomprehensible except to its 
illuminati, the Distillierbuch proved to be a 
practical work upon distillation, written in 
language (Middle German) quite under- 
standable to the ordinary citizen of the time, 
for whose use it was intended by the author. 
For this reason, Brunschwig's Book of Distilla- 
tion, one of the early printed books devoted to 
the practical phase of alchemy, and one of 
the earliest on applied chemistry written in 
German, has become a bridge which enables 
us to make the transition from alchemy to 
chemistry, along with such other published 
works as Agricola's De Re Metallica (1556) 
and Libavius' Alchymia (1595). 

The Book of Distillation consists of three 
divisions: the first is devoted to the various 
forms of apparatus for distillation — furnaces, 

1 Dr. Abrahams is Research Associate, Library of 
The College of Physicians of Philadelphia, 19 South 
22nd Street, Philadelphia, Pennsylvania 19103. 

This paper is part of a lengthy work supported by 
a grant from the American Philosophical Society. 



stills, condensers, receivers, various sources of 
heat (i.e., from fermenting horse-dung, ant- 
hills, souring dough, sun's rays), and so on, 
thus providing a full account of the art of 
distillation; the second deals with the descrip- 
tion of the medicinal plants which are to be 
subjected to the process of distillation; the 
third division gives the uses of these distillates 
(or "waters," as they are called) in the treat- 
ment of the ills of man's flesh. The book's 
three divisions are illustrated by the use of 
charming woodcuts, making this work the 
earliest attempt at so depicting chemical 
apparatus and chemical manipulations. The 
result is a practical work upon distillation and 
its applications. Many editions and various 
revisions appeared during the century which 
followed, a major one being Liber de arte 
distillandi de compositis (1512), the so-called 
Grosses Distillierbuch, or Large Book of Distilla- 
tion (1). It needs to be added that the Book 
of Distillation is of interest not alone to his- 
torians of chemistry. Historians of botany, 
medicine, pharmacy, interior design, the art 
of woodcuts and social historians will find 
much to interest them in this work. 

The fact that a surgeon would concern 
himself with the preparation of medicines 
seems to require an explanation. In his time, 
the physician was a university graduate, 
devoted to the ideas of the medical authorities 
of olden times. The ills which required treat- 
ment with scalpel or other instruments were 
left to the barber-surgeon, as being beneath 
the dignity of treatment by the physician. 
Surgeons often became city-poor doctors, 
and thus treated great numbers of patients, 
who could not afford to pay the large fees of 
doctors, nor purchase the costly medicines of 
the pharmacists. Surgeons developed a 
progressive attitude to the enlarging of their 



149 



150 



MARION B. SAVIN AND HAROLD J. ABRAHAMS 




knowledge, fostered by their wide professional 
experience, and learned to ignore the hide- 
bound theories of contemporary physicians, 
who refused to abandon their veneration of 
Greek and Arab texts. For surgeons, it was 
only a short step from soiling their hands in 
the treatment of human flesh to soiling their 
hands in experimenting with the materials 
and methods of manufacture of medicinal 
preparations. Thus, surgeons became distillers 
of medicinals, basing their high regard for 
the process of distillation upon the widely 
held belief that by this process the very soul 
of an herb could be parted from the coarse 
"gross") diluent, be captured in the dis- 
tillate, and be made to render a far more 
potent medicinal account of itself than could 
the crude, undistilled drug. The time of 
Paracelsus and the iatrochemists was near at 
hand, and the sixteenth century brought vast 
changes, one being the application of chemi- 
cal principles to pharmacy and medicine. 
The latter disciplines spurred further develop- 
ments in chemistry in a reciprocal fashion. 
Paracelsus was friendly to the idea of separat- 
ing the active medicinal principles from the 



gross matter of herbs and drew inspiration 
from the work of the group of surgeons, of 
which Brunschwig was the leader. (It is 
therefore necessary to take into account the 
work of the Strassburg surgeon in the domain 
of chemistry, if we are to make a true assess- 
ment of Paracelsus and iatrochemical in- 
fluences.) 

As to Brunschwig's distillation products 
(or "waters," as he called them), they may 
furnish us with many reasons to smile toler- 
andy, or even chuckle, the while that we 
remember, on the other hand, the many 
virtues of his contribution. Was it humor, 
informed by deep wisdom and understand- 
ing, which led him to observe that persons 
suffering from melancholia would profit from 
engaging in distillation activities, because the 
hot, moist atmosphere attendant upon such 
work would be beneficial to those having a 
"cold, dry complexion," which was the root 
of this malaise? (Our modern equivalent 
might be the steam bath.) 

The purpose of the present paper, with its 
excerpts from The vertuose boke of the distyl- 
lacyon of all maner of waters of the herbes . . . 



HIERONYMUS BRUNSCHWIG'S BOOK OF DISTILLATION 



151 



translated] into Englysshe out of Due he by Lau- 
rence Andrew, London, ca. 1530, is to supply 
an opportunity to smile a little, sometimes 
with Brunschwig, sometimes at him, as we 
try to obtain a better understanding and a 
more complete picture of a fifteenth century 
mind. 

(Note to the reader: Laurence Andrew, Brunschwig's 
English translator, followed the practice of indicating 
an abbreviation by placing a bar or line above a 
letter which precedes the omitted letter, viz., co- 
plexios for complexions. The letters u, y and i of 
those times are now v, i, and j, respectively.) 

I 

Brunschwig ascribes great importance to 
the color of his raw material : 

Chapter CLX Water of Capones (capons) : 
[160] "Capo in latyn. The best parte and tyme 
of hys dystyllacyon is ye shall take a blacke 
capon fourc or fyue yere olde/and worowe and 
pluck hym without wettynge of water/therafter 
cut hym in foure quarters and put away all the 
grece fro hym/and wasshe well and make 
clene the entrayles/and then choppe hym in 
small peces/and dystyll hym than per Alem- 
bicum/or in a helmet lyke other waters . . . The 
same water dronke in the mornig/at none/and 
at nyght . . . coforteth and strengtheneth the 
nature of the body . . . and reioyseth the spy- 
ryte . . . cawseth appetyte to eate meate . . . and 
wythdryueth all dysseases frome the harte + 
stregtheth a persone so moch that it is sene on 
hys body. In the mornyng and at nyght the 
face wasshed wyth the same water and lette 
drye agayne by hym selfe causeth the face to be 
fayrc and clene." 

Nor was a black hen any safer, if it strayed 
within reach of the Brunschwig distillatory: 

Chapter CXXXI Water of hennes (hens) 
[131] "Gallina in latyn . . . worowe a good blacke 
henne . . . Tha put of all feders . . . and distil 
the same in an helmet. After that put the water 
in a glasse and dystyll it per balneum marie. 
Water of hennes shall be gyuen to drynke to 
them whych haue ben so longe seke/that he is 
hole consumed and is hole feble and faynte/it 
is good aboue mesure for such one/for it gyueth 
hym so moche vertue + strengtheth hym so 
moche/that al the medecyns haue mcruayll of 
the same." 



Nor were black calves any safer: 

Chapter CLIIII Water of calves blodc 
[154] "Sanguis vituli in latyn. The best parte and 
tyme of hys dystyllacyon is/the bloode of a black 
calfe/and the blacker the better . . . [the distil- 
late] warmeth + confortcth the membres 
greued with the Palscy/rubbed with the same 
water in the mornyng 4- at nyght well warinc 
and clothes wet therein and warmc layde there- 
upon. The same water confortcth the membres + 
senewes ..." 

Chapter CLV Water of Calfes blode and longues 
to gyddrc 

[155] "Sanguis + pulmo vituli in latyn. The 
best parte of his dystyllacyon is/the blode 4- 
longues of a blacke calfe chopped to gyder + 
dystylled per Alebicu . . . good for consumynge 
membres/the membres rubbed therwith and 
let drye agayn by hym selfe/but yf the body 
consumeth than the same water must be dronke 

Half a loaf is better than none: 

Chapter CLVI Water of Calfes Lyuer 
[156] "The beste lyuer for to dystyll is of a blacke 
calfe wha it can be gotten . . . 

Chapter CCVII Water of Oxce blode 
[207] Sanguis bouinus in latyn. The best parte 
and tyme is of a black oxe which goth in a good 
pasture where as many flowres do growe/ 
dystylled in the May." [good against paralysis 
and gout] 

Chapter CCXXII Water of the gall of an oxe 
[222] "Fel tauri in latyn. The best gall is of a 
blacke oxe/whan they may be goten/and it 
shall be dystylled in July /or in the canyculer 
dayes. 

Of the same water an houre before night in 
the iye doth withdryue the fleces and spottes 
in the iye. The same water is good agaynst the 
worme in the fynger/clowtes wette therin + 
layd theron twyse or thryse contynuynge/and 
at eche tyme wet agayne . . . than the worme 
dyeth." 

Chapter CCXLII Water of blacke Cheryes 
[242] "Cerasa nigra in latyn . . . The best parte 
of the dystyllacyon of the great blacke cheryes is/ 
the moste blackest that may be goten + dys- 
tylled ..." [good against dropsy, palsy, swell- 
ings, Iaske] 

Geriatricians, please note ! 

Chapter CCC Water of the herbe of pelether 
[300] "Herba helebori nigri ... I haue sene a 



152 



MARION B. SAVIN AND HAROLD J. ABRAHAMS 



man at Stracsborowe whiche was a hondred and 
thyrty ycre oldc whych had euery day without 
upon his hade the powder of the same herbe/the 
quantyte of an hazel nutte + lycked therof/and 
he abode in good helthe unto the tyme of 
hys naturall endynge of lyfe." 

II 

In which the author of the Book of Distilla- 
tion reveals his failure entirely to emancipate 
himself from alchemy's acceptance of astrol- 
ogy and superstition: 

Chapter CLVI I Water of creuys 

[157] "Cancer in latyn/the beste parte + tyme 
of hys dystyllacyon is the quycke creuyces whan 
the mone is at full/stamped and dystyllcd 
. . ." [for palsy, burns] 

Chapter CCXII Water of pechc leues 
[212] "Folis persicorum in latyn . . . The best 
parte and tyme of theyr dystyllacyon is/the 
leues stropped of in the cressynge of the mone/ 
whan she is almoste full/dystylled in the ende 
of the may." 

Chapter CCXLV Water of saynt Johnswortc 
[245] "Scopia regia/yperycon vel herba sancti 
Johannis vel herba perforata in latyne . . . Muri 
domus consperci cu aqua ista/valet contra 
diabolicam illusionem . . ." [when the walls of 
the house are sprinkled with this water it is 
effective against diabolical illusion] 

Chapter CCXXX Water of Rue or herbe of 
grace 

[230] "Ruta in latyn . . . who so hathe the same 
water in his howse can nat be hurte of the deuyll 
by the grace of god . . ." 

Ill 

Chapter CLXVIII Water of moderworte 
[168] "Citraria vel Melissa in latyn ... Of the 
same water dronke a spone full fastynge/ 
causeth in a man to haue sharpe wytte/good 
understandynge/and good memory and re- 
mebraunce/for to kepe and remembre euery 
thynge that is possyble for a man to remembre 
. . . The same water dronke an ounce and a 
halfe/causeth them to be mery and refressht 
agayn/which were afore sore greued with 
anger /it maketh also softe and good myndes/ 
and an amyable colour . . . The same water 
preserueth a man from gray heres/twyse dronke 
of the same water in a day . . . and the heres 
wet with the same water/and let drye agayn 
by hym selfe . . . The same water is very good 
for hym whose tonge is greued with such sekenes 



nat of nature/that he can not speke/hc shall 
take a blew wollen clothe wet in the same 
water/and the tongue often wasshed thcrwith 
and than it shall become hole agayne/and the 
spechc also." 

Chapter: — "A fayre addycyon of an other 
master of the vertue of aqua vitc . . ." 

(first citation) 

". . . Aqua vite . . . gyueth also yonge corage 
in a person/and causeth hym to haue a good 
memory and remembraunce. It puryfyeth the 
fyue wyttes of melancoly + of all unclennes 
whan it is dronke by reason + measure. That 
is to understandc fyue or syx droppes in the 
mornyng fastyng with a sponefull of wyne/ 
usyng the same in the maner aforsayde the yll 
humours can nat hurt the body/for it with- 
dryueth them out of the vaynes . . ." 

Chapter XCI Of fenell herbe water 
[91] "Feniculus in latyn . . . Of the same water 
dronke amonge/at eche tyme an ounce 4- the 
drynke myxced therewith wythdryueth and 
taketh away the lechery." 

Chapter CIX The water of the yellow vyolettes 
[109] ". . . Of the same water dronke in the 
mornynge and at nyghte at eche tyme an ounce/ 
is good for them that haue loste theyre wyttes 

Dronke of the same water/at eche tyme an 
ounce and a halfe/thre or foure wekes con- 
tynuynge/cawseth the women to be fruytfull 
... In the mornynge 4- at nyght dronke of the 
same water at eche tyme an ounce 4- a halfe 
contynuynge vii or viii dayes is good for men or 
women which euer be besy in worke of genera- 
cyon . . . the same water sharpeneth the wyttes 
4- understandynge . . . the same water . . . re- 
ioyseth and cawseth to be mery the harte and 
mynde of a man . . . and it warmeth the mary 
in the bones and dryeth oute the colde blode." 

Chapter LIX Water of Cardo benedictus 

(first citation) 

[59] "Cardo benedyctus in latyn . . . The same 
water dronke in the same mesure is good against 
the payn comynge in the hed aboue the eye/ 
named Epicranea/that is wha a body thynketh 
that a nayle is beten thrughe his hede. 

The same water . . . cawseth good memory/ 
and conforteth the remembraunce." 

Domestic tranquility: 

Chapter LXVI Water of valerian 
[66] "... A man and a wyfe maryed to gyder 
and can not well agre to gydre/them shall be 
gyuen to drynke of the same out of one vessell 
or pot and they shall agree." 



HIERONYMUS BRUNSCHWIGS BOOK OF DISTILLATION 



153 



Further notes on memory: 

Chapter LXXIX Water of Veronica 

(Jirst citation) 

[79] ". . . dronke of the same water is pryncy- 
paJly good abouc all waters for the memory 
and remembraunce/whS the hede is enoyntcd 
therwith outwardc/and let drye by hym selfe 
agayne bycawsc it confortcth the hede and 
braynes/and lyghtcth the tongue/and clenseth 
the blode." 

And again! 

Chapter CLXXII Water of Maryolayn 
[172J ". . . Samsucus in latyn . . . dronke of the 
same water . . . and the hede enoyntcd ther- 
with/causeth a good rcmembraunce and 
memory . . ." 

On mental and physical hygiene: 

Chapter LXXIII Water of straw beryes 

{first citation) 

[73] "Frage in latyn ... It is good for them 
whose nature mountcth upwardc in the face 
and the face becometh red/yf the face be wasshed 
therwith/it vanyssheth awaye . . . 

The mouthe often wasshed with the same 
water/is good agaynst a stynkyngc mouthe . . ." 

Silence is golden (Returning to Veronica) : 

[79] ". . . In lykewyse synketh the great anger + 
upblowynge of the longue/whan a dragma of 
the powder of the same drye herbe veronica is 
myxed wyth the same water of the Veronica/ 
and so dronke/bycawsc of no membre cometh 
so moche payn and woo as fromc the longue/for 
whan the membres be in reste and quyetre/than 
the longue is euer rysynge up and labourynge/ 
whether a person be slepynge or watchynge/ 
euer is the longue labouryng with blowynge 
and unclenes/. . . The wynd is come all orygy- 
nally from the longues. Therfore it is a very 
wyse man whyche that can refrayne the tongue 
and the longue." 

Chapter CCIII Buglossa 

[203] ". . . In lykewyse I my selfe haue sene in 
the towne of Couelence in Almayne a scole 
mayster which had studyed so moche that he 
had loste his wyttes. Than came there an un- 
lerned Empyricus and dyde gyue hym to drynke 
of the same water /and chopped the herbe 
for his meate/and the herbe stamped/he dyd 
laye unto hys hede plaster wyse/thre or foure 
wekes contynuynge/wherwith he became fully 
hole and well amended/and gate his wyttes 



agayn/and he studyed moche more than he 
dyd before 

. . . dronke [thrice daily] an ounce and a halfc + 
his wync myxced therwith causeth good un- 
derstandynge + memoryc 

For the perfect host: 

... It is saydc also yf a great company were 
syttynge at dyner or soupper/and were spryn- 
kled with the same water /it sholdc cause them 
all to be mcry . . ." 

Courage ! 

Chapter CCXXVI Water of Rosemary 

{first citation) 

[226] "Ros marinus in latyn . . . dronke of the 
same water/at eche tyme two ouces/cawseth a 
man to be courageus for it confortcth the sub- 
stance of the harte/and it is also good agaynste 
the wofull payne of the harte." 

Chapter CCLXXV Water of Wormewode 
[275] "Absinthium in latyn. . . The same water 
hath ryght merueylous great vertues/for it is 
said of dyuers persons/that the iuce or water of 
the same herbe hath be gyuen for a token in 
maner of incantacyon unto great captayns or 
conductours of an hoste or armey/beleuynge 
that thrugh suche a token/they sholde haue 
vyctorye agaynste theyr enemyes but how it 
shold be occupyed/I can nat tell 

. . . Put of the same water in ynke that ye 
wyii wryte with/and the bokes that be wrytcn 
thcrwith/shall be preserucd from the eatynge 
of the myce." 

IV 

For the bald set: 

Chapter: — ■ - 

"A fayre addycyon of an other master of the 
vertue of aqua vite. . ." {second citation) 

"Aqua vite . . . whan it is dronke and the hede 
enoynted therwith the space of xx dayes/it 
heleth alopiciam/or wha it is dronke fastynge with 
a lytell tryacle It causeth the here to grow well + 
kylleth the lyce and flees . . ." 

Chapter CXXI Of Hony water 

[121] "Mel in latyn . . . The hede ofte wasshed + 

rubbed therwith causeth to grow fayrc + loge 

heres." 

Chapter CCXXVI Water of Rosemary 
[226J . . . "The hede wasshed with the same 
water/and lette drye agayne by hym selfe/ 
preserueth the fallynge out of the heres + 
cawseth more for to growe." 



154 



MARION B. SAVIN AND HAROLD J. ABRAHAMS 



Chapter CCIX Water of percely 

[209] "Petrociliurn in latyn. . . Any place that is 
enoynted with the same shall waxe balde/and 
it takes away the heres of the same place." 

V 

Tall tales department: 

Chapter: "A fayre addycyon. . ." Brome flowre 
water. 

". . . whoso drynketh in the mornynge ii or 
iii ouces is preserued from the thyrst all that 
dayc." 

Chapter LXV Water of Fumytory 
[65] "Fumus terre in latyn. . . Drok of the same 
in the mornynge + at nyght at eche tyme two 
ouces/four or fyue wekes cotynuynge is good for 
euyll fauoured faces 4- maketh them fayr + 
pale of colour." 

Chapter LIX [Cardo benedictus again] 

{second citation) 

[59] ". . . It happened upon a tyme that a man 
was slepyng under a tree + a snake of an ell 
longe was crept in his throt + to hym was gyue 
fyue or syx droppes of the same water /and anone 
the snake came out agayn 4- dyed." 

For broken bones: 

Chapter LXIIII Water of centory 
[64] "Centaurea in latyn . . . whan one hath 
broken a bone in his body than he shall drynke 
of the same water luke warme in the mornynge + 
at nyght at eche tyme an ounce for it heleth 4- 
consolydeth toged agayn." 

Chapter LXIII Water of straw beryes [again] 

(second citation) 

[73] ". . . The same dronk in the mornlge + 
at nyght is good for them that hathe broken a 
bone or a legge." 

Jungle medicine: 

Chapter LXXIX Veronica [again] 

(third citation) 

[79] ". . . It is redde of a lytel venymous worme 
smaller than a Scorpyon/whyche kylleth the 
yonges of the lyon with his venymous stynges. 
And whan the lyon perceyueth it/then he 
choweth of the same herbe/and layth it upon 
the venymous swellynge of his yoges/than it shal 
be no harme to the but they shall become hole 
agayne/ 

Also it is redde of a bere/wha he is to fatte/ 
tha he eateth of y same herbe/wha he can get 
it/ + therwith he becometh lene and well 
dysposed and bolde/lykewyse the bere when he 



hath sene great oxcen/than he desyreth to haue 
and to eate the fattest of them/but yet he is 
afrayde. But as sone as he hath eaten of the same 
herbe/than he becometh bolde and taketh the 
fattest oxe without feare/ 

It is redde of the bere/whan he is seke than he 
eateth pysmer/4- tha he becometh hole and 
eased/and after that he eateth so moche of them 
that he can not dygest them in his nature/than 
he falleth somtyme in swowne and fayntnes. 
Than he eateth of the herbe Veronica/ 4- thereof 
he getteth the laskc + therof he become agayn 
hole. It is redde that the garye water snakes 
engendreth them with the ealc/a fysshe called 
Anguilla in latyn. And whan the eale hath 
coceyued/tha she becometh so colde of the 
venymous nature of the snayle that she can not 
suffre the water no longer /and than she crepeth 
often out of the water and seketh the same herbe/ 
and eateth it + than the yonges must nedes 
departe from her/and dye before or they be 
warped. And yf it be that the eale can not fynde 
the same herbe/than the yonges kyll her or they 
be warped ..." 

Chapter CLXIX Water of May or parke floures 
[169] "Lilium conuallium in latyn. . . The same 
is good for any body that is hurt or harmed by 
styngynge of any venymous beste or other 
worme/as a spynner/or suche lyke . . . What 
maner of persone that is stynged with a bee/or a 
waspe/or with other stynges/he shall laye a 
cloute wet in the same water therupon in the 
mornyge + at nyght . . . 

In the mornynge and at nyght dronke of the 
same water/. . . and the hede therwith enoynted/ 
conforteth the braynes/and strengtheth the 
mynde or the wyttes . . . 

With the same water often the tongue 
enoynted/causeth one to come to his speche 
agayne. . ." 

Rosemary once more: 

Chapter CCXXVI (third citation) 

[226] ". . . In the forsayd maner dronke of the 
same water/sharpeneth the tongue and cawseth 
well to speke. And no body can tell the myght 
and vertue of the same water. 

. . . the face wasshed with the same water/ 
causeth a fayre and clere face. 

. . . The same water cawseth a body to appere 
longe tyme fayre and yong/whan it is dayly 
used/myeced with his drynke a lytell/and 
outwarde therwith rubbed. 

... It causeth the wome to be frutful wha 
they make a bath of his decoccio/the same bath 
is also a bathe of lyfe/a restraynynge + a with- 



HIERONYMUS BRUNSCHWIGS BOOK OF DISTILLATION 



155 



drawyng of agc/a rcnewyng of a body/for it Chapter Line 

hath many secret vertucs . . ." 

„ . 3 

Chapter CCXLVIII Water of corona regia ^ 

[248] ". . . The same water is good for them that 2 

hauc euyl hasty moued wyttcs/cloutcs wet ^ 

therin + bounde upon the hedc. The same water 

shall be dronk of noble prynces and gouernurs of 

lodes + regyons that sholdc be wysely 

goucrned + of all them that wolde goucrne 

themselfe by wysdom." 



For the ladies: 



65 2 
4 



Chapter LXXIX Water of Veronica 

(fourth citation) 

[79] ". . . In the mornynge fastynge dronke two 
ounces of the same water v or vi wekes con- 73 
tynuynge/causcth a body to become lene of 2 
flesshe . . . 

The same water with the powder dronke in the 
maner aforsayd is good for women that be fatte 
and wolde fayne bcre chylde + be lene/bycause 
she myght the better conceyue/for it dysposeth 2 
the women to conccyuc. And lykewysc as fyre 79 
purgeth the golde/so purifyeth the same water 3 
the wome for to conceyue a chylde." 3 

Chapter CLXVII Water of Lauendre 
[167] "Lauendula in latyn ... A nutte shell full 
of the same water myxced with other water/ 
wherof is made dowgh/so what brede is bake of 
the same dowgh shall nat waxe moldy." 



Annotations 2 

Note to the reader: To facilitate the use of the follow- 
ing annotations, the Roman numeral designations 
of the text have been replaced here by Arabic nu- 
merals and the citations placed in numerical order, 
rather than preserving the order in which the cited 
passages appear in the text of the present paper. 

Where any chapter is drawn upon more than 
once, the citations are designated as "first," "second," 
and so on. 

Chapter Line 

59 (first citation) 

4 eye — eyes 

4 a nayle is beten — a nail is beaten, 
(a rather effective description!) 

2 Sources : 

1 . The Oxford English Dictionary. Edited by James 
A. H. Murray, Henry Bradley, W. A. Craigie, C. T. 
Onions, Oxford, 1933. 

2. Anglo-Saxon Dictionary. Bosworth and Toller, 
London, 1954. 

3. The Century Dictionary and Cyclopedia. William 
Dwight Whitney, Ed., New York, 1895. 



(second citation) 
ell — forty-five inches 
gyue— give 
whan — when 
toged — together 

fumytory — common name for a 
species of the genus Fumaria 
(from Latin-fumus terrae, "smoke 
of the earth," so named because 
of its odor) 
drok — (dronk), drunk 
euyll fauored faces — evil-favored 
faces. (If Brunschwig merely 
meant acne this might not be a 
very tall tale.) 

(first citation) 
whose nature mounteth upwarde 
in the face and the face be- 
cometh red — a surge of emo- 
tion^) 

(second citation) 
mor ni ge — morni ng 

(first citation) 

wha — when 
hede — head 

(third citation) 

lytel — little 
yoges — young 
the — them 

redde of a bere/wha he is to fatte — 
read about a bear that when he 
is too fat 
9 lene — lean 
10 sene — seen 

1 5 seke — sick 

1 6 pysmer — ants 

19 laske — loose bowels 

20 garye — misprint for gray? 

21 engendreth — beget or propagate 

22 - coceyued — conceived 

27 warped — the young brought forth 
prematurely 

Note: The eel and the snake, being members of 
different classes of vertebrates, could hardly mate 
or beget offspring. Though the eel has gills it can 
scarcely be likened to a snail, and the failure to "suffrc 
the water" is rather reminiscent of an amphibian 
which has undergone metamorphosis, during which 
the gills are absorbed and air-breathing lungs have 
developed. One cannot but wonder whether Brunsch- 
wig's source has mistaken some sort of salamander 
(an elongated amphibian) for the eel (a fish). The 
reference to the killing of the eel by its young, if 
they cannot leave the mother's body, is a great 
misunderstanding of the reproduction of the eel. 



156 



MARION B. SAVIN AND HAROLD J. ABRAHAMS 



It may be that the eel (or salamander) was filled 


Chapter 


Line 


with 


parasitic 


worms, which were mistaken for 




3 


crcssynge of the mone — waxing of 


young eels. 








the moon 








222 


4 


canyculer days — canicular days 


Chapter Line 








(dog-days), a certain number of 






(fourth citation) 






days before and after the heliacal 




8 


fyre — fire 






rising of the dog-star 


109 


5 


thre — three 


5 




iye — eyes 




12 


mary — marrow 


7 




worme in the fynger — ringworm(?) 


121 


2 


ofte — often 


226 




( first citation) 




4 


loge — long 




3 


ouces — ounces 


131 


3 


tha — then 






(third citation) 




3 


of— off 




3 


And no body can tell the myght 




3 


helmet — a type of distillation 






and vertue of the same water — 






apparatus very commonly used 






This belief was held as early as 






by Brunschwig, in which a cone- 






Avicenna, and perhaps even 






shaped head was fitted to the 






earlier. It is a specimen of the 






lower part of the still. 






extravagant trust which was 


131 


5 


balneum marie — water-bath 






placed in certain herbs from 




9 


medecyns — physicians 






time immemorial (and con- 




9 


meruayll — astonishment 






tinues to be, by some persons). 


154 


5 


greued — troubled 




10 


wome — women 




6 


clothes — cloths 




11 


decoccio — decoction 


155 


1 


to gyddre, (to gyder) — together 


230 


3 


deuyll — devil 




4 


per Alebicu — per Alembicum, i.e., 


245 


3 


cu — cum 






in an alembic 




5 


diabolicam illusionem — exactly 




6 


than — then 






what a diabolical illusion is, 


156 


I 


lyuer — liver 






presents a difficulty. 




3 


wha — when 


248 


2 


euyl hasty moucd wyttes — vicious 


157 


1 


creuys — crawfish 






temper (?) 




3 


mone — moon 




4 


gouernurs — governors 


160 


4 


worowe — strangle 




5 


15des — (londes), lands 




6 


grece — grease 


275 


2 


merueylous — marvelous 




6 


fro — from 




3 


dyuers — divers 




6 


clene — clean 




3 


iuce — juice 




7 


peccs — pieces 




4 


token — a pledge of authenticity 




9 


coforteth — comforts 




6 


beleuynge — believing 




10 


reioyseth — rejoices 




7 


occupyed — used 


167 


1 


lauendre — lavender 




9 


ynke — ink 




3 


dowgh — dough 




10 


bokes — books 




4 


bake — baked 




11 


myce — mice 




4 


waxe — become 


300 


4 


hade — hand 


168 


4 


remebraunce — remembrance 










9 


heres — hairs 


Chapt 


er called "A fayre addycyon of another 




12 


sekenes — sickness 


master of the vertue of aqua vite ..." 




12 


nat — not 


(This 


section appears at the end of Brunschwig's 




12 


speke — speak 


book, and the implication is that it was written by 




13 


blew — blue 


another person.) 




14 


than — then 






(first citation) 




14 


hole — whole, (well) 


Line 2 




aqua vite — distilled 


169 


1 


water of May or parke floures — 






spirits; brandy 






lily of the valley(?) 


3 




gyueth — gives 




4 


spynner — spider 


5 




fyue wyttes of melancholy — (liberates) 


203 


2 


Couelence — Coblenz 






the five senses from the effects of 




3 


scole — school 






"black bile," which is a depressant, 




4 


Empyricus — empiric, quack 






(according to belief then current) 


207 


1 


oxce — ox 


6 




unclennes — toxic matter 


212 


1 


leues — leaves 


10 




yll humours — body fluids in a morbid 



HIERONYMUS BRUNSCHWIG S BOOK OF DISTILLATION 



157 



Chapter Line 

state; (according to medical beliefs 
of the times, the cardinal humours were 
the blood, cholcr [yellow bile], 
melancholy [black bile], and 
phlegm). 
1 1 vaynes — veins 

(second citation) 

5 alopiciam — baldness 

6 tryacle — treacle or theriac, a mixture of 

many medicinal substances, formerly 
believed to prevent or cure the 
effects of poisons or poisonous bites. 

Acknowledgment 

The authors express their very deep thanks to Mr. 
Lessing J. Rosenwald of the Alverthorpe Gallery, 



Jenkintown, Pennsylvania, for his kind permission to 
study his copy of the rare edition of Brunschwig's 
Book of Distillation. 

REFERENCES 

1. Sicerist, Henry E. : Hieronymus Brunschwig and 

His Work. New York, 1946. 

2. Sudhoff, Karl: Deutsche Medizinische Inkunabeln. 

Studien zur Geschichte dcr Mcdizin. 
Heft 2/3. Leipzig, 1908, pp. 61-69. 

3. Stillman, John M. : Chemistry in Medicine in 

the Fifteenth Century. Scientific Monthly 
6, 1918, pp. 167-175. 

4. Sicerist, Henry E. : Medieval Medicine. Phila- 

delphia, 1941. 

5. Castiglioni, Arturo: A History of Medicine. 

New York, 1941. 



A Dozen Portraits in the College Hall 1 



By FRED B. 

ONE afternoon last year, Mr. Theo- 
dor Siegl, Conservator of The 
Philadelphia Museum of Art, on 
invitation of the Committee on Mutter 
Museum and College Collections, made a 
walking tour of the College's portrait col- 
lection. At that time, Drs. Wood, Gibbon 
and Dyer, Mrs. Wade and Miss Garner, 
Drs. Gefter, Holling and I were led on a 
memorable excursion into the fields of art 
and history. Mr. Siegl's expert review and 
suggestions about the care and repair of 
various paintings and drawings were 
heeded and since then Mr. Will Brown, 
also a member of the Art Museum staff, 
has worked at the task of refurbishing the 
College's fine arts holdings — supported by 
a special fund voted by Council. The re- 
sults of this effort have far exceeded the 
cost and we have become increasingly 
aware of the beauty and value of this re- 
markable trove of Americana. I have 
chosen a dozen of the College's portraits to 
describe briefly at this gathering — por- 
traits outstanding in terms of both artistic 
merit and subject interest. These portraits 
are located in the Hutchinson Room — off 
the first-floor rotunda, in adjacent Thom- 
son Hall, and in the second-floor foyer. 
May this sample inspire us and stimulate 
our interest in them and other art works 
here which time does not permit me to 
discuss. 

Hanging above the paneled fireplace in 
the Hutchinson Room is a three-quarter 
length oil portrait of Dr. Nathaniel Chap- 
man (1780-1853), painted by the English- 
born portrait painter Thomas Sully in 

1 Read at "an evening at the College," arranged 
by the Entertainment Committee, 2 May 1969. 

2 Chairman, Committee on Miitter Museum and 
College Collections, The College of Physicians of 
Philadelphia. 



OGERS, m.d.~ 

1817 and presented to the College by Mrs. 
Henry Cadwalader Chapman in 1909. 

Thomas Sully (1783-1872), first a pupil 
of Gilbert Stuart and later (in London) of 
Benjamin West, established himself in 
Philadelphia (1810), where he enjoyed con- 
siderable popularity. His dashing brush- 
work, seen in the Chapman portrait, 
brings charm to its subject. Sully's other 
sitters included four Presidents: Jeflerson, 
Madison, Monroe, and Jackson. In her 
youth, Queen Victoria sat for him. 

Dr. Nathaniel Chapman, a native of 
Virginia and descendant of Sir Walter 
Raleigh, was a prominent teacher of 
clinical medicine at his alma mater, the 
University of Pennsylvania, for forty-six 
years. A polished and witty aristocrat who 
traveled in the highest circles of his day, 
Chapman displayed literary and political 
interests early in life by writing for The 
Port Folio, a magazine founded in Phila- 
delphia in 1801, and by editing four vol- 
umes of Select Speeches, Forensick and 
Parliamentary, in 1807-08. His marriage 
to Rebecca Cornell Biddle of Philadelphia, 
in 1808, was a fortunate one and their 
family life was cordial. It is said that the 
young doctor decided to marry his wife- 
to-be on hearing about her — before their 
actual meeting! 

Chapman received his M.D. degree in 
1801 and, after three years study abroad, 
settled down to practice in Philadelphia. 
In 1817 he established the Medical Insti- 
tute of Philadelphia; it provided instruc- 
tion for practitioners and has been con- 
sidered the first 'postgraduate' medical 
school in the United States. With the 
publisher Matthew Carey, in 1820, Chap 
man founded the Philadelphia Journal of 
the Medical and Physical Sciences, which 
seven years later adopted its present title, 



A DOZEN PORTRAITS 



1 VI 



the American Journal of the Medical 
Sciences. This periodical is still published 
in Philadelphia, by Lea &: Febiger, and is 
now the nation's oldest continuous medical 
journal. Chapman was also a promoter of 
the U. S. Pharmacopoeia, a drug com- 
pendium first issued in 1820 and another 
publication still active in the world. 

Epidemic cholera struck Philadelphia 
during the summer of 1832 — a dreadful 
episode lasting several months. During 
this period Dr. Chapman and his col- 
leagues rendered valuable service in treat- 
, ing the sick and setting up hospital 
facilities for their care. Chapman was one 
of thirteen physicians awarded silver 
pitchers by the City of Philadelphia for 
their heroic labors. The handsome pitcher 
given to him is now on display here — a gift 
in 1966 of his great-great grandson, Mr. 
Sydney Thayer, Jr., of Bryn Mawr. 

Prominent professionally and socially, 
Nathaniel Chapman was chosen as the first 
president of the American Medical Asso- 
ciation at its organizational meeting in 
Philadelphia on May 5, 1847. This cap- 
stone of his career attested to the fact that 
he stayed at the helm despite professional 
controversies which raged around him in 
a period of medical feuds and stormy as- 
sociates. In the spring of 1850, illness 
forced him to relinquish his teaching and 
civic interests. He died on July 1, 1853, and 
was buried at St. Stephen's Episcopal 
Church — a church which he had helped 
found in 1823. 

A charcoal sketch of Sir William Osier 
(1849-1919), done by John Singer Sargent 
(1856-1925) at his London studio in 1914 
and presented to this College in May of 
that year by Lady Osier, shows the Cana- 
dian-born physician in a pensive mood. 
The artist Sargent, whose father was an 
early ophthalmologist in Philadelphia, was 
born in Italy and trained as a painter at 
the Beaux-Arts in Paris. His first exhibit 
(1877) attracted favorable notice, and by 
1885, when he had settled in London, his 



talents were in demand. Frank in depic- 
tion, his portraits of beautiful women, 
symbolic murals (Boston Public Library), 
and landscapes in water color are much 
admired. 

William Osier aroused enthusiastic ac- 
claim of colleagues and pupils during a 
distinguished career in Canada, the United 
States and England. A man of wide culture 
and an expert physician, Osier was a 
prolific writer and speaker on medical and 
literary topics. In 1884, at age 35, he was 
called to the chair of clinical medicine at 
the University of Pennsylvania where he 
actively pursued clinical and clinico-patho- 
iogical studies. He afterwards referred to 
his Philadelphia stay, especially his experi- 
ences in the wards and deadhouse at 
"Biockley," as the most instructive of his 
career. (The deadhouse, now the Osier 
Memorial Museum, still stands on the 
Philadelphia General Hospital grounds.) 
While in Philadelphia, Osier was also an 
active member of the Library Committee 
of The College of Physicians of Philadel- 
phia, and he continued an interest in its 
resources after leaving in 1889 to become 
the first professor of medicine at the newly 
founded Johns Hopkins Medical School at 
Baltimore. 

In Philadelphia too, Osier met and 
married his wife, the widow Grace Revere 
Gross; they were wed at St. James' 
Episcopal Church in May 1892. Two years 
later he returned to Philadelphia to speak 
at the opening of The Wistar Institute of 
Anatomy and Biology — and he willed his 
brain to that institution to enrich its 
neuroanatomical museum. Sir William 
and Lady Osier died at Oxford, England; 
their ashes and his 7,600 volume historical 
library are now at his medical alma mater, 
McGill University, Montreal, Canada. 

The oil portrait of Dr. Charles Caldwell 
(1772-1853), painted by Thomas Sully, 
conveys the belligerent personality of the 
subject. A native of North Carolina and 
medical graduate of the University of 



160 



FRED B. ROGERS 



Pennsylvania (1796), Caldwell occupied 
the chair of natural history at the Univer- 
sity from 1810-18. A pupil and friend of 
Dr. Benjamin Rush, he subsequently 
quarreled with him and the trustees. In 
1818 Caldwell left Philadelphia for Lexing- 
ton, Kentucky, where he became professor 
of materia medica at Transylvania Univer- 
sity, whose medical department he had 
helped to organize. He moved to Louisville 
in 1837 and established the Louisville 
Medical Institute, afterwards merged into 
the University of Louisville as its medical 
school. Rivalry between the towns of 
Louisville and Cincinnati brought Cald- 
well a prominent role in the medical af- 
fairs of the Mississippi Valley. 

Caldwell's father had come to this 
country from the North of Ireland. The 
son, whose early opportunities for educa- 
tion were limited, demonstrated extraor- 
dinary ability — rising to head a literary 
academy at age 18. While a medical stu- 
dent he served valiantly in the yeliow fever 
epidemic of 1793 in Philadelphia. Later 
he was surgeon of a brigade during the 
"Whiskey Insurrection" in the summer of 
1794, an uprising of farmers in western 
Pennsylvania against an excise tax on dis- 
tilled liquors. His Autobiography, pub- 
lished after his death (1855), is a remark- 
able repository of medical scandal. Wil- 
liam Osier, discussing "Some Aspects of 
American Medical Bibliography" in 1902, 
wrote of this book: "Caldwell's Auto- 
biography is a storehouse of facts (and 
fancies!) relating to the University of 
Pennsylvania, to Rush and to the early 
days of the Transylvania University and 
the Cincinnati schools. Pickled, as it is, in 
vinegar, the work is sure to survive." 

An oil portrait of Dr. William Potts 
Dewees (1768-1841), painted by John 
Neagle (1796-1865), was given to the Col- 
lege by its Fellow, Dr. I. Minis Hays 
(1847-1925). The likeness of Dr. Dewees 
shows a handsome, winning face. 

Boston-born, John Neagle's professional 



career was spent in Philadelphia. He 
began work as an assistant to a coach 
painter and by ability rose to be a re- 
spected artist. His portrait of Gilbert 
Stuart is the best one of that fascinating 
personality. Neagle's famous full-length 
canvas, "Pat Lyon at the Forge," graces the 
Pennsylvania Academy of the Fine Arts, as 
does a landscape, "View on the Schuylkill," 
the Art Institute of Chicago. 

William Dewees was the great-grandson 
of Swedish immigrants; his mother was a 
daughter of Thomas Potts, founder of 
Pottstown, Pa., where his grandson was 
born. After medical training at the Univer- 
sity of Pennsylvania, Dewees began prac- 
tice at age 21 with an M.B. degree. After 
practicing for some time, he returned to 
the medical school and took his M.D. 
degree in 1806. His doctoral thesis was en- 
titled, "Lessening Pain in Parturition;" 
Prof. William Shippen, Jr. called its mes- 
sage an historic one. 

In 1810 a professorship in obstetrics was 
established at the University of Pennsyl- 
vania with the proviso that student "at- 
tendance should be optional for gradua- 
tion." Dr. Thomas Chalkley James was 
appointed to this chair. In 1825, Dewees 
became adjunct professor, and nine years 
later succeeded James. Dr. Dewees built up 
a large obstetrical clientele and, "patients, 
it was said, postponed their confinements 
until he was at leisure" (Waterson). In 
1824 he published his System of Midwifery, 
which ran through twelve editions; in 

1825, A Treatise on the Physical and 
Medical Treatment of Children — the first 
American textbook on pediatrics; and in 

1826, On the Diseases of Females, both 
books running to ten editions. 

An oval portrait of Alexander von 
Humboldt (1769-1859), German explorer, 
naturalist and statesman, was painted by 
Charles Willson Peale (1741-1827) on the 
former's visit to Philadelphia in June 1804. 
The artist, then aged 63, completed this 
portrait in three days; his sitter was 35 



A DOZEN PORTRAITS 



K.l 



years old. In this situation one genius 
captured another on canvas. For Peale was 
a man, like his friend, Benjamin Franklin, 
of catholic interests and diverse talents. 
Best remembered as a portrait painter, he 
was also a civic leader, soldier and natu- 
ralist. A pupil of John Singleton Copley in 
Boston and Benjamin West in London, 
Peale in 1805 was instrumental in founding 
the Pennsylvania Academy of the Fine 
Arts. Versatile in applied science and art, 
he painted portraits of many leaders and 
visitors in the early years of our nation. 
(George Washington sat for Peale at least 
seven times, and from these sittings the 
artist produced sixty portraits of him.) 
Thrice married, Peale was the father of 
seventeen children, several of them very 
talented. 

Alexander von Humboldt, a disciple of 
the great Goethe, traveled in South Amer- 
ica, Mexico, and the United States during 
the years 1797-1804. He explored the 
course of the Orinoco and found the com- 
munication between the waterways of the 
Orinoco and Amazon Rivers. The Hum- 
boldt Current — a cold Pacific Ocean cur- 
rent flowing north along the coasts of Chile 
and Peru, Humboldt River in Nevada, 
Humboldt Bay ofl California, and Hum- 
boldt Glacier — the world's largest — in 
Greenland, honor his name. So does the 
mineral Humboldtine (ferrous oxalate) 
and Humboldt's Sea on the surface of the 
moon. (Humboldt University in Berlin is 
! named for the philologist, diplomat and 
man of letters, Wilhelm von Humboldt 
[17G7-1835], the elder brother of Alex- 
ander.) 

From 1808-27 Alexander resided in 
Paris, collaborating with the French 
scientist, Gay-Lussac, in chemical experi- 
ments. Humboldt is credited with the first 
description of choke-damp and fire-damp 
in mines, and he devised a gas-mask and 
safety lamp to protect miners from these 
dangers. In 1829, under the patronage of 
Czar Nicholas I of Russia, he led an ex- 



pedition into North and Central Asia, by 
which was extended our knowledge of 
mountain chains, plant distribution and 
climate. In 1830 Humboldt became envoy 
from Prussia to France, serving in this 
capacity for eighteen years. His last and 
greatest work, Kosmos, a five-volume 
treatise on natural philosophy published 
between 1845-62, was widely translated. 

A full-length oil portrait of Dr. William 
Thomson (1833-1907), painted by Thomas 
Eakins (1844-1916), adorns the rear wall of 
the College hall named in his memory. 
This large (74 x 48") portrait is our out- 
standing item of recent years, the one most 
borrowed for exhibit elsewhere and com- 
manding the highest insurance premium. 

Thomas Eakins, a life-long resident of 
Philadelphia, studied art and anatomy 
both at home and abroad before he began 
teaching at the Pennsylvania Academy of 
the Fine Arts (1876-86). Employing the 
technical skill of an engineer, he laid out 
perspective with mechanical drawings, and 
his effort to capture body movement led 
him to become a pioneer experimenter 
with motion pictures. A realist, he painted 
without romantic gloss, and late in life 
began to enjoy a little of the superlative 
reputation his name now holds. The Gross 
Clinic (Jefferson Medical College) and The 
Agneiu Clinic (University of Pennsylvania) 
are favorite medical canvases by Eakins. 

Dr. William Thomson, a graduate of 
Jefferson Medical College in 1855, was an 
early ophthalmologist in Philadelphia and 
a pioneer in the study of refraction. With 
Dr. William F. Norris, also a prominent 
Fellow of this College, he promoted the 
systematic refraction of patients' eyes. 
With Dr. S. Weir Mitchell, Thomson drew 
attention to the importance of "eye-strain" 
as a cause of headache, which refraction 
often relieved. He was also interested in 
color-blindness and modified Holmgren's 
wool-skein test for its detection. Himself 
affected with hypermetropia, he made im- 
portant investigations on this condition 



162 



FRED II. ROGERS 



and also on astigmatism. Dr. Thomson 
served with the Union Army Medical 
Corps during the Civil War, was surgeon 
to Wills Hospital from 1872-77, and par- 
ticipated in the International Medical 
Congresses of 1872, 1876 and 1881. 

A portrait of Dr. Plunket Fleeson 
Glentworlh (1769-1833), painted in oils by 
Gilbert Stuart (1755-1828), depicts the sub- 
ject wearing a ruff, jabot and lace shirt- 
cuffs, and holding a book in his right 
hand. This portrait, which was exhibited 
in the Pan-American Exposition at Buffalo, 
N. Y., in 1901, was donated to the College 
in 1948 by the doctor's great-grandchildren, 
Henry R. and Marguerite L. Glentworth. 

Gilbert Stuart, born in Rhode Island, 
was the most celebrated portrait painter of 
his day. For five years (1775-80) he studied 
in London under Benjamin West, whose 
star pupil he became. After achieving 
fame in London and Dublin, he returned 
to America in 1792. In New York and 
Philadelphia (1792-96), Stuart made three 
portraits of Washington, painted from 
life. Among Stuart's other sitters were 
Presidents Jefferson, Madison, and Mon- 
roe. In 1805 he settled in Boston, where his 
reputation allowed him to select his com- 
missions. At their best his character studies 
are lifelike and luminous, and they have 
given him an unrivaled reputation in 
American portraiture. 

Dr. Plunket Glentworth was the son of 
Dr. George Glentworth (1735-92), one of 
the founders of this College in 1787, and 
his wife nee, Margaret Linton. The son, 
who is mentioned in the famous novel, 
"The Red City," by Dr. S. Weir Mitchell, 
took his M.D. degree at the University of 
Pennsylvania in 1790. In the following 
year he served as secretary of the Univer- 
sity, and in 1792 was elected a Fellow of 
The College of Physicians of Philadelphia. 
He counted George Washington among his 
patients. In a letter dated April 20, 1797, 
our first President wrote: "Thanks to the 
kind attention of my esteemed friend Dr. 



Glentworth . . . than whom no nobler man 
nor skilful physician ever lived, I am now 
restored to my usual state of health." 

Dr. Glentworth, in 1805, was one of the 
founders of the Pennsylvania Academy of 
the Fine Arts at Philadelphia. Thereafter 
he moved to Trenton, N. J., where he 
served as a warden of St. Michael's 
Episcopal Church from 1820-24. During 
this interval he was physician to Joseph 
Bonaparte, exiled brother of Napoleon I, 
at the former's estate, "Point Breeze," in 
nearby Bordentown. A busy and fashion- 
able practitioner, Dr. Plunket Glentworth 
died in January 1833, and was interred in 
the family vault at Old St. Paul's Epis- 
copal Churchyard, Philadelphia. 

An oil portrait of Georges Cuvier (1 769— 
1832), painted by Rembrandt Peale (1778- 
1860), pictures an eminent French natu- 
ralist and statesman. The red ribbon of the 
Legion d'Honneur decorates his left coat 
lapel. 

A son of Charles Willson Peale, Rem- 
brandt Peale was, like his father, a pupil 
of Benjamin West, and on his return from 
Europe, devoted himself chiefly to por- 
traiture. An original member of the Na- 
tional Academy of Design, in 1825 he suc- 
ceeded John Trumbull as president of the 
Academy of Fine Arts. Rembrandt Peale's 
idealized likeness of George Washington 
(1823) hangs in the National Capitol. 

Georges Cuvier was born in Mont- 
beliard, France. Inspired by the work of 
Buffon, he studied natural history at the 
Academy of Stuttgart, Germany. In 1795 
he was appointed assistant to the professor 
of comparative anatomy at the Museum 
National d'Histoire Naturelle in Paris. An 
investigator in zoology, geology and 
paleontology, Cuvier greatly advanced the 
science of comparative anatomy. His name 
is recalled by the embryological ducts of 
Cuvier: two short venous trunks in the 
fetus opening into the atrium of the heart; 
the right one becomes the superior vena 
cava. 



A DOZEN PORTRAITS 



163 



Cuvier's greatest work is Le Rcgne 
Animal (The Animal Kingdom), 1817, a 
treatise in which he arranged all organisms 
in the four great classes of vertebrates, 
mollusks, radiates and articulates. He be- 
came perpetual secretary of the French 
Academy of Science in 1803, and councilor 
of the Imperial University five years later. 
Napoleon I made him a councilor of state 
in 1814, and Louis Philippe named him a 
peer of France seventeen years later. 

At Cuvier's suggestion, in 1819, the 
world's first independent professorship of 
pathological anatomy was established at 
the University of Strasbourg. Dr. Jean F. 
Lobstein (1777-1835), author of a Traite 
d'anatomie pathologique (1829), occupied 
this chair. Lobstein's disease, osteogenesis 
imperfecta, recalls his name. 

Cuvier made significant contributions to 
science, but he was a foe of the evolution- 
ary ideas of Lamarck and Darwin. Louis 
Agassiz (1807-73), Swiss-born physician- 
naturalist of Harvard University, was a 
favorite pupil of Baron Cuvier at the Paris 
Jardin des Plantes before coming to the 
United States. 

The bust portrait of Joseph Louis Gay- 
Lussac (1778-1850), by Rembrandt Pcale, 
is a companion in size and style to that of 
Georges Cuvier by the same artist. Each 
was presumably painted from life before 
Peale returned to Philadelphia from Eu- 
rope in the year 1810. The artist's signa- 
ture appears in the lower right corner of 
the canvas front on the Gay-Lussac por- 
trait: "painted in wax by Rem. Peale 
1810.'' 

Gay-Lussac, an eminent French scientist, 
pioneered in the study of the gaseous 
state. In 1804 he made the first balloon 
ascension for the purpose of scientific in- 
quiry, rising on a second ascent in that 
;year to over 23,000 ft. above sea level. This 
work placed him among the founders of 
meteorology. In 1808 he traveled to Italy 
with Alexander von Humboldt to study 
the law of magnetic declination. In the 



same year he was appointed professor of 
physics at the Sorbonne — a position be- 
held for twenty-four years. In 1810 he also 
became professor of chemistry at the 
Ecole Polytcchnique in Paris. During the 
years 1823-24, the brilliant German chem- 
ist, Justus von Liebig, worked with him in 
his laboratory. 

With Humboldt, Gay-Lussac carried on 
ail investigation of the polarization of 
light. In chemistry he discovered ethyl 
iodide, hydrosulfuric and hypochlorous 
acids. Gay-Lussac's gas law recalls his 
name: at a constant pressure the volume of 
a given mass of perfect gas varies directly 
with the absolute temperature. 

An oil portrait of Dr. Thomas Cooper 
(1759-1839), painted by Charles Willson 
Peale, captured the scowl of an agitator 
and freethinker of his day. A student at 
University College, Oxford, trained in law 
at the Temple, Cooper attended anatomi- 
cal lectures in London, took a clinical 
course at Middlesex Hospital and later at 
Manchester attended patients under a 
preceptor. But for his father's insistence 
upon the law, he probably would have be- 
come a practicing physician. In 1817 a 
University of New York conferred upon 
him the honorary degree of M.D., which 
he flaunted thereafter. 

In 1794 Cooper emigrated from England 
when he was threatened with persecution 
because of his strong sympathies for the 
French Revolution. A prolific author, he 
had already published writings on educa- 
tion, history, law, electricity and optics. In 
the United States, he practiced law at 
Northumberland, Pa. until 1804, then 
served as a state judge for Luzerne County 
until 1811. While editor of a violently- 
Republican newspaper, Cooper's slander- 
ous attacks on President John Adams in 
the matter of the Alien and Sedition Acts 
led to his being fined and imprisoned. 
Adams dubbed Cooper a "learned, in- 
genious, scientific, and talented madcap." 
Judge Cooper was subsequently impeached 



164 



FRED B. ROGERS 



and removed from the Pennsylvania bench 
because of the freedom ami force of his 
opinions. 

Like his friend and fellow-exile, the Rev. 
Joseph Priestley, with whom he collabo- 
rated in scientific research, Cooper was 
esteemed by President Thomas Jefferson. 
The latter procured Cooper's appointment 
in 1811 as first professor of natural science 
and law at the University of Virginia. At 
that time Jefferson called him "the great- 
est man in America in the powers of his 
mind and acquired information and that 
without single exception." Cooper, how- 
ever, resigned the appointment due to the 
delay in opening the university and be- 
cause his Unitarian religious views were so 
hotly denounced by the Virginia clergy. 

After teaching chemistry at Dickinson 
College (1811-15) and the University of 
Pennsylvania (1815-19), Cooper accepted a 
chair in chemistry at the University of 
South Carolina. Elected president of the 
institution in the following year (1820), he 
also taught political science. His Lectures 
on the Elements of Political Economy, 
published in 1826, was a pioneer textbook 
on the subject. 

Though heralded for his enlightened 
views on education, Cooper's vehement 
anticlericalism led to a 'trial' for atheism, 
and to his resignation from the South 
Carolina university presidency in 1834. A 
champion of free trade and state sover- 
eignty and an advocate of the institution 
of slavery and political nullification, he 
helped prepare the way for secession. At a 
spirited anti-tariff meeting at Columbia, 
S. C, in 1827, Cooper asked his listeners, 
"Is it worth our while to continue this 
Union of States, where the North demands 
to be our masters and we are required to 
be their tributaries?" 

President John Quincy Adams shared 
his father's dislike for "Old Coot" — to 
borrow a student nickname applied to 
Cooper by the gynecologist, Dr. J. Marion 
Sims. Adams wrote in 1838 of the "English 



atheist South Carolina Professor, Thomas 
Cooper, a man whose very breath is 
pestilential to every good purpose." It is 
recorded that at Cooper's funeral, his firm 
supporters and ardent detractors found it 
difficult not to resort to blows! 

In contrast to the stormy petrel just de- 
scribed, the oil portrait of Dr. Robley 
Dunglison (1798-1869), painted by 
Thomas Sully in 1868, reflects the kindly 
manner of the man. With full beard, it 
shows the well-liked physician late in life. 
Dr. Dunglison and his wife, Harriett, were 
devotees of music: this portrait formerly 
belonged to the Musical Fund Society, of 
which Dunglison was a president, and 
from which it was purchased for the Col- 
lege in 1957 by Drs. Jonathan E. Rhoads 
and Lewis C. Scheffey. 

A native of Keswick, England, trained in 
London, Edinburgh and Paris, Robley 
Dunglison took his M.D. degree at the 
University of Erlangen in Germany (1823). 
Two years later he was imported by 
Thomas Jefferson to establish the school of 
medicine at the University of Virginia. 
Moving thence to the University of Mary- 
land (1833-36), he finally settled at the 
Jefferson Medical College of Philadelphia 
(1836-68), where he was professor of physi- 
ology and later dean of the faculty. Dun- 
glison was a respected leader during an era 
of stormy Hippocrats. Dr. Oliver Wendell 
Holmes once described him as "the great 
peace-maker." A skilled practitioner, he 
attended at times Presidents Jefferson, 
Madison, Monroe, and Jackson. 

Dr. Dunglison compiled an excellent 
medical dictionary which went through 23 
editions, and wrote a wide array of text- 
books on nearly every subject but surgery. 
Much interested in pediatrics and preven- 
tive medicine, he recognized a type of 
chronic hereditary chorea in adults, now 
called Huntington's chorea, thirty years 
before Dr. George Huntington fully de- 
scribed the disorder in 1872. Dunglison's 
course of lectures on medical history was 



A DO/.F.N PORTRAITS 



165 



published posthumously by a physician- 
son as the "History of Medicine from the 
Early Ages to the Commencement of the 
Nineteenth Century." 

An oil portrait of Dr. William Williams 
Keen (1837-1932), president of this Col- 
lege in 1900-01, painted by James L. Wood, 
shows the great surgeon in a sitting pose 
with his Phi Beta Kappa key from Brown 
University (1859) conspicuously displayed. 
Mr. Wood, the artist, was an exhibitor at 
the Pennsylvania Academy of the Fine Arts 
from 1893-99. He painted four other por- 
traits owned by the College, those of Drs. 
Joseph Leidy, Frederick A. Packard, Na- 
thaniel A. Randolph, and Horatio C. 
Wood. 

W. W. Keen is best remembered as a 
pioneer in neurosurgery; he successfully 
removed a meningioma in 1888, tapped 
the cerebral ventricles in the following 
year, and gradually acquired wide experi- 
ence in the extirpation of brain tumors. He 
was an eloquent American supporter of 
Dr. Joseph Lister's doctrine of antisepsis, 
and was among those who welcomed the 
great British surgeon on his visit to Phila- 
delphia in 1876. 

In his final year of medical school, Keen 
left Jefferson Medical College to serve 
with the Union Army. Returning to ob- 
, tain his M.D. degree in 1862, he saw two 
more years of service as a medical officer — 
I including the Battle of Gettysburg. Also 
■ during the Civil War he worked with Drs. 
S. Weir Mitchell and George B. Morehouse 
at the Turner's Lane Military Hospital in 
Philadelphia, a 275-bed center for neuro- 
logical casualties. These three men made 
important studies of gunshot and other 
wounds which were afterward expanded 
into an important book, Injuries of Nerves 
and their Consequences (1872). 
Dr. Keen became professor of surgery at 
; the Woman's Medical College of Penn- 
, sylvania in 1884, and assumed the chair of 
, surgery at Jefferson five years later. In 



September 1893, when a financial panic 
was threatening the nation, President 
Grover Cleveland's physician urged exci- 
sion of a large malignant-looking ulcer 
from his patient's hard palate. After care- 
ful planning, Cleveland was operated upon 
aboard a yacht, the Oneida, off New York 
City. Two surgeons — Drs. Joseph D. Bry- 
ant of New York and W. W. Keen of 
Philadelphia, an anesthetist, a dentist and 
an internist were the professional team. 
Cleveland's right upper maxilla was re- 
sected and a prosthesis fitted. The opera- 
tion having been kept a secret, the 
President was able to appear before a joint 
meeting of Congress a month later — to 
bolster confidence and avert financial 
turmoil. Dr. Keen subsequently wrote an 
account of the surgery, and Cleveland's 
right upper jaw with several teeth and the 
cheek retractor Keen used on that historic 
occasion are now in the Mutter Museum. 

Dr. Keen served with the Army Medical 
Corps in three wars: Civil War, Spanish- 
American War, and World War I. From 
1876-89 he taught anatomy to students at 
the Pennsylvania Academy of the Fine 
Arts. Of Baptist persuasion, he was 
deeply religious and wrote a book entitled 
/ Believe in God and Evolution (1922). He 
died at the age of 95, full of years and 
honor. 

With the portrait of Dr. Keen, painted 
in 1901, we come into this century and 
conclude our brief tour. Like Cesare, the 
somnambulist in the cinema classic The 
Cabinet of Dr. Caligari, the casual visitor 
to The College of Physicians of Philadel- 
phia may be unaware of the wonders 
around him. Although I cannot compare 
myself to the late Werner Krauss in the 
role of guide, it is a pleasure to introduce 
you to a few of the treasures of art, litera- 
ture, science and healing in the handsome 
Hall of the College. Each person is free to 
choose a favorite from among the varied 
attractions that we share. 



List of the Kate Hurd Mead Lectures in 
Medical History, I-XX 



THE Kate Hurd Mead Class of 1888 
Lectures in Medical History, of the 
Woman's Medical College of Pennsyl- 
vania, are regularly presented at The Col- 
lege of Physicians of Philadelphia under 
the joint auspices of its Section on Medical 
History and the Woman's Medical College 
of Pennsylvania. A number of the lectures 
were not published in the College's Trans- 
actions & Studies because of the imminent 
appearance of the materials in books sched- 
uled for publication by the lecturers. 

I. Pepper, O. H. Perry: Medical History in 
Medical Words (13 Jan. 1950), Trans. & 
Stud. Coll. Phys. Philadelphia, 4th s., 18: 
29-37, April, 1950. 
II. Bett, Walter R. : The Pathology of 
Genius (13 Feb. 1950). 

III. Shryock, Richard H.: Women in Ameri- 

can Medicine (14 April 1950). 

IV. Leake, Chauncey D. : The Old Egyptian 

Medical Papyri (17 April 1952). 
V. Nettleship, Anderson: A View of What 
Primitive Man Thought of Disease (26 
Feb. 1953). 

VI. Tucker, David A., Jr.: Medical Education 
and Practice in the Ohio Valley, 1780- 
1860 (25 March 1954). 
VII. Stevenson, Lloyd G. : Biography versus 
History, with Special Reference to the 
History of Medicine (21 April 1955), 
Trans. & Stud. Coll. Phys. Phila., 4th s., 
23: 83-93, Aug., 1955. 
VIII. Finch, Jeremiah S. : The Lasting Influence 
of Sir Thomas Browne (3 April 1956), 
Trans. & Stud. Coll. Phys. Phila., 4th s., 
24: 59-69, Aug., 1956. 
IX. Stevenson, R. Scott: The Changing Scene 
in Harley Street (9 April 1957), Trans. 
& Stud. Coll. Phys. Phila., 4th s., 25: 
87-96, Aug., 1957. 



X. Tilton, Eleanor M. : Science and Senti- 
ment: a Study of Oliver Wendell Holmes 
(15 April 1958), Trans. & Stud. Coll. 
Phys. Phila., 4th s., 26: 89-98, Aug., 1958. 
XI. West, Herbert F. : Rabelais, Sterne, and 
Osier (7 April 1957), Trans. & Stud. Coll. 
Phys. Phila., 4th s., 27 : 60-73, Oct., 1959. 
XII. Miller, Genevieve : The Unicorn in Medi- 
cal History (19 April I960), Trans. & 
Stud. Coll. Phys. Phila., 4th s., 28: 80-93, 
Oct., 1960. 

XIII. Wright, Arthur Dickson: The History of 

Opium (21 Feb. 1961), Trans. & Stud. 
Coll. Phys. Phila., 4th s., 29: 22-27, 
July, 1961. 

XIV. Schmidt, Carl F. : Some Experiences with 

Chinese Drugs (27 March 1962), Trans. & 
Stud. Coll. Phys. Phila., 4th s., 30: 66-72, 
Oct., 1962. 

XV. Corner, George W. : George Hoyt Whip- 
ple, Nobel Prize Pathologist (19 March 
1963), Trans. & Stud. Coll. Phys. Phila., 
4th s., 31: 40-41, July, 1963. 
XVI. Rose, Edward: John Coakley Lettsom and 
English Medicine in the Georgian Period 
(21 April 1964), Trans. & Stud. Coll. 
Phys. Phila., 4th s., 32: 57-59, Oct., 1964. 
XVII. Bell, Whitfield J., Jr.: James Hutchin- 
son . . . Letters from an American Student 
in London (26 April 1966), Trans. & 
Stud. Coll. Phys. Phila., 4th s., 34 : 20-25, 
July, 1966. 

XVIII. Polcino, Sister M. Regis: The Medical 
Mission Sisters (18 April 1967), Trans. & 
Stud. Coll. Phys. Phila., 4th s., 35: 1-25, 
July, 1967. 

XIX. Lesky, Erna : History of the Vienna General 
Hospital (13 Feb. 1968). 
XX. Rogers, Fred B. : Dr. William Bryant 
1730-86: American Physician and Anti- 
quary (15 April 1969), Trans. & Stud. 
Coll. Phys. Phila., 4th s., 37: 99-105, Oct., 
1969. 

W. B. McDaniel, 2d 



166 



Memoir of William Bates 
1889-1967* 



By NORBERT 

DR. William Bates was born in 
Philadelphia on April 11, 1889. 
He received his B.S. degree from 
the University of Pennsylvania in 1912 and 
was awarded his medical degree from the 
same institution in 1915. Dr. Bates in- 
terned at the Hospital of the University of 
Pennsylvania. He served his country in 
World War I in Base Hospital Unit No. 20 
from 1917 to 1919. From the rank of Major 
he rose to the rank of Lieutenant Colonel. 
The University of Pennsylvania appointed 
him Professor of Surgery in 1935 and 
Chairman of the Graduate School of Sur- 
gery in 1946. 

Dr. Bates was happiest when he was 
teaching and helping his residents and 
students at the University of Pennsylvania 
Graduate School and on the staffs of the 
hospitals with which he was associated. 
These included the Graduate Hospital, 
Presbyterian Hospital, Medical Chirurgi- 
cal, Howard, Babies, American Stomach, 
and Wills Eye. He had a great talent for 
organizing. He spent many hours daily to 
improve the courses and the curriculum for 
the Graduate School. He wrote many 
papers covering a broad scientific spectrum 
but he had a special interest in the relief 
of pain and its differential diagnosis. He 
was given the Strittmatter Award by the 
Philadelphia County Medical Society for 
the year 1953. Later he continued his 
teaching as Director of Education and 
Research at the Harrisburg Polyclinic 
Hospital in 1957 until his death. 

• Read before The College of Physicians of Phila- 
delphia, 9 October 1968. Prepared and published at 
the request of the Council of The College of Phy- 
sicians of Philadelphia. 



. SCHULZ, M.n. 

Dr. Bates was a very active member of 
many societies. He served as President for 
each of the following organizations: Aescu- 
lapian Club, Medical Club of Philadel- 
phia, Physicians Motor Club, Philadelphia 
County Medical Society and the Penn- 
sylvania State Medical Society. He served 
as a trustee for the U.S. Chapter of the 
World Medical Organization. Dr. Bates 
was active in the American Medical Associa- 
tion in the House of Delegates. He was a 
member of The College of Physicians of 
Philadelphia and of the Academy of Surgery 
of this city. 

Dr. Bates was a member of the Union 
League of Philadelphia. He was a trustee 
of the First Presbyterian Church of Phila- 
dephia. He was a 32nd Degree Mason. 

His pace was formidable. Despite the 
demands of a surgical practice as Chief of 
Surgery in no less than two hospitals 
simultaneously, he still found time to aid 
a young aspiring surgeon or student. He 
radiated kindness and humor. Hosts of 
Philadelphians loved him as a friend. He 
was widely sought to act as toastmaster 
with his ready fund of stories. Who, having 
heard, can forget his version of the Biblical 
David and Goliath? 

Dr. Bates and Marie Bergstresser of Har- 
risburg were married in 1919. They shared 
a devoted relationship until her death in 
1955. They are survived by a son William 
Bates, Jr., a vice president of the Phila- 
delphia National Bank, and a daughter, 
Mrs. Robert W. Moore, residing in Easton, 
Pennsylvania. Five grandchildren are 
living and remembering him. 

William Bates died quietly at a friend's 
home in Harrisburg, on February 22, 1967. 



168 



NORBERT J. SCHULZ 



His family, friends, medical colleagues and 
patients have been spiritually and mate- 
rially enriched by his life. The memory of 
this man remains warm and glowing de- 



spite the passing of time. This happy 
after-image is a living tribute to one who 
sincerely dedicated his life to serving his 
fellow man. 



Memoir of Martin W. Clement 
1 88 1- 1 966* 

By JOHN KAPP CLARK, m.d. 



MARTIN W. CLEMENT, Honorary 
Associate of The College of Phy- 
sicians, a descendant of prominent 
Colonial ancestors, was born in Sunbury, 
Pennsylvania, on December 5, 1881. In 1901, 
he obtained his B.S. degree from Trinity 
College in Hartford, where he had been a 
member of St. Anthony Hall and a member 
of the varsity football and basketball squads. 
He went to work almost immediately with 
the Pennsylvania Railroad, where he was 
rapidly promoted to positions of increasing 
responsibility from his initial job as an 
eleven-dollar-a-week rodman. He was ap- 
pointed Vice President in charge of opera- 
tions in 1926, elected to the Board of Di- 
rectors in 1929, and became President in 
1935. At this time his predecessor, the late 
General William W. Atterbury, described 
him as the ablest railroad executive in the 
country. Under Mr. Clement's leadership, 
the railroad completed the electrification of 
its eastern lines, started by his predecessor 
during the depression years, the largest im- 
provement program in the road's history. 
Also constructed during his presidency was 
the main Pennsylvania Station at 30th and 
Market Streets in Philadelphia. It was under 
his leadership that the railroad met the tre- 
mendous transportation challenge of World 
War II, running 29,670 extra trains with 
400,00 cars to transport almost one and a 
half trillion tons of freight and 18 million 
servicemen, exclusive of furloughs. He be- 
came a trusted consultant of General 
George C. Marshall and many other high 
government officials. 
During his career, he maintained an ac- 

• Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



tive interest in his alma mater and is cred- 
ited as being creator of the modern Trinity 
College. Mr. Clement was extremely inter- 
ested in young men and was responsible for 
recruitment of many Trinity students who 
were both athletes and good scholars. He 
felt strongly that the education they were 
to receive should train them to fulfill their 
responsibilities as citizens of the community. 
On one occasion he said, "Some men are 
only intelligent and are of no use at all. 
Unless a teacher, a doctor, a scientist, a law- 
yer, a minister or a businessman has in addi- 
tion to intelligence good judgment, common 
sense, integrity and good physical stamina, 
he cannot excel in his profession or as a 
citizen." On numerous occasions he ex- 
pressed his strong feeling that the qualifica- 
tions of an individual most likely to result 
in success were a willingness to accept indi- 
vidual responsibility and a sense of self- 
discipline. His own life represented one of 
the best examples of the results of such per- 
sonal characteristics. 

Mr. Clement was greatly interested in 
medical affairs being, among other things, 
one of the Board of Managers of the Hos- 
pital of the University of Pennsylvania. The 
College of Physicians of Philadelphia also 
became one of his major interests. He re- 
spected its rich traditions and service to 
medicine and determined to do what he 
could to insure its continued viability and 
vigor. His influence with several charitable 
foundations led to the donation of about 
half the funds needed for the construction 
in the early 1950's of the new wing to the 
College building. 

He was director of numerous corporations 
and a member of many clubs and organiza- 
tions including the Society of the War of 



169 



170 



JOHN KAPP CLARK 



1812, the Baronial Order of the Magna 
Carta, the Colonial Society of Pennsylvania, 
the Society of Colonial Wars and the Sons of 
the Revolution. He was also a member of 
the Philadelphia Club, the Union League, 
the Merion Cricket Club, the St. Anthony 
Club, the Rabbit and the Gulph Mills Golf 
Club. In personal life his hobby was garden- 
ing. 

At 3 o'clock on the afternoon of Sep- 
tember 1, 1966, every train of the Pennsyl- 
vania Railroad came to a halt for one min- 
ute while 59,000 employees stood silent. 
The moment marked the beginning of the 



hour of his funeral service in the Church of 
the Redeemer in Bryn Mawr, where he had 
been a member for many years and at one 
time served on the vestry. Martin Clement 
is survived by two sons, Harrison H., a 
Philadelphia attorney, and James H., of 
Kingsville, Texas; a daughter, Miss Alice 
W. Clement, of West Berlin, Germany; a 
brother, Colonel John K. Clement, of Har- 
risburg; nine grandchildren and five great- 
grandchildren. He will be remembered by 
his many friends and associates as a man 
who profoundly influenced their lives for 
the better. 



Memoir of Edward Foulke Corson 
1883-1967* 

By HERMAN BEERMAN, m.d. 



ON December 2, 1967, The College of 
Physicians of Philadelphia lost one 
of its distinguished Fellows, Edward 
Foulke Corson. Dr. Corson was elected to 
Fellowship in 1914. His life was dedicated 
to medicine, especially dermatology, and to 
his family. 

Dr. Corson was born at Jefferson Bar- 
racks, Missouri, on November 29, 1883. He 
was the son of Mary Ada Carter Corson, one 
of the Carters of Virginia, and Major Joseph 
K. Corson, M.C., an Army medical officer 
and recipient of the Congressional Medal of 
Honor. 

After spending his early years in various 
Army posts throughout the West and in 
Washington, D.C., he came to Plymouth 
Meeting, Pa., on his father's retirement. He 
immediately entered Germantown Acad- 
emy. After completion of his studies in this 
venerable institution, Edward Corson en- 
tered the University of Pennsylvania. He 
was awarded the degree of Doctor of Medi- 
cine in 1906. He spent two years as an intern 
at the Episcopal Hospital. Following this, 
he entered practice in Cynwyd, Pa. 

Because of his intense interest in derma- 
tology, Dr. Corson became closely associated 
with the late Dr. Frank Crozier Knowles, 
also a University of Pennsylvania graduate, 
who was connected with various clinics in 
I Philadelphia and subsequently became Pro- 
fessor of Dermatology at Jefferson Medical 
College (1920-1948). At Jefferson, Dr. Cor- 
son's status rose from Associate in Derma- 
tology (1921-1925) to Clinical Professor in 
1939. This latter position he held until 1947 
when he was made Professor Emeritus. In 

• Prepared and published at the request of die 
Council of The College of Physicians of Phila- 
delphia. 



1949 he served as interim head of the de- 
partment. 

Dr. Corson also gave generously of his 
time to a number of Philadelphia hospitals: 
Children's Hospital, 1910-1930; Presby- 
terian Hospital, 1911-1921, and the Chest- 
nut Hill Hospital, 1921-1939. 

In addition to his ability as a practitioner 
and teacher, Edward Corson was interested 
in investigation and was the author of a 
number of papers on various aspects of 
dermatology, including poison ivy derma- 
titis, the length of hair, and especially the 
"cutaneous changes associated with rimless 
spectacles." This last mentioned study, 
made with Dr. Herbert A. Luscombe, the 
present head of the Department of Derma- 
tology at Jefferson, was instrumental in 
helping to popularize the use of spectacles 
with rims. 

Dr. Corson was in the "Founders" group, 
who were the first individuals to be certified 
by the American Board of Dermatology and 
Syphilology, as it was then known. He was 
active in many medical organizations in 
addition to The College of Physicians. 
Among them are the American Dermatolog- 
ical Association, the American Academy of 
Dermatology, and the Philadelphia Der- 
matological Society. He was a member of 
the Sigma Xi, honorary scientific group 
organization. He was President of the Phila- 
delphia Dermatological Society in 1924 and 
1951. During his second term, he had the 
distinction of presiding on the occasion of 
the Fiftieth Anniversary Meeting of the 
Philadelphia Dermatological Society. In 
1911 and in 1934 Dr. Corson was Chairman 
of the Section on Dermatology and Syphil- 
ology of the Medical Society of the State 
of Pennsylvania. 



171 



172 



HERMAN BEERMAN 



As a result of his heritage and boyhood 
spent in pioneer historic sites, Dr. Corson 
developed a profound interest in history, 
especially military history. This led to his 
hobbies, among which was the collection of 
British War medals, which Dr. Corson gave 
to the Mutter Museum and which in 1966 
were presented to the Museum of Medical 
History of Johannesburg, South Africa. 

He belonged to the Military Order of the 
Loyal Legion, as did his father before him. 
He also held membership in the Society of 
Indian Wars, the Welcome Society and the 
Union League of Philadelphia. Early in his 
career, Dr. Corson joined the Army Medical 
Corps and served in France during World 
War I and later in the Army of Occupation 



in Germany. He ultimately attained the 
rank of Lieutenant Colonel. 

Dr. Corson was a devoted husband and 
father. In 1917 he married the former 
Esther Bisler. This union resulted in a 
daughter, Mrs. Edward W. Wetmore, a son, 
Dr. Joseph K. Corson, and seven grand- 
children. Dr. Corson was extremely proud 
that his son became a dermatologist and As- 
sociate Professor of Dermatology at Jeffer- 
son Medical College. 

Always a quiet, soft-spoken man, Dr. Cor- 
son had many admirers. His opinion, based 
on keen observation, was highly respected 
by his colleagues. His passing is a great loss 
to the medical world. 



Memoir of John Arthur Daugherty 
1902-1968* 

By ALLEN W. CROWLEY, SR. 



TOHN Arthur Daugherty, m.d., was 
I born August 12, 1902, at Carlisle, 
Pennsylvania. His early education 
was in Harrisburg. He was graduated from 
the University of Pennsylvania in 1924 and 
from Jefferson Medical College in 1928. 
After internship and residency training at 
the Harrisburg Hospital, he remained 
there as an attending physician until his 
sudden death at his home on August 28, 
1968. 

Besides being Chief of Staff of the Har- 
risburg Hospital just prior to his death, 
he was also a member of many state and 
national professional organizations, includ- 
ing the American Diabetic Association, 
American Heart Association, and the 
American College of Physicians. He was a 
delegate to the Pennsylvania Medical So- 
ciety. He became a member of The College 
of Physicians of Philadelphia in 1955. 

He became a corporate member of the 
Medical Service Association of Pennsyl- 

• Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



vania (Blue Shield) in 1944, elected Presi- 
dent in 1945, and became Chairman of 
the Board in 1966. During this time he 
served one term as President of the Na- 
tional Association of Blue Shield Plans. 
At the time of his death he was a Director 
and Chairman of the By-Laws Committee. 

His greatest service to organized medi- 
cine has been in the area of prepay medi- 
cal care. He was largely responsible for the 
steady growth of the Blue Shield Plans, 
both state and national. It was through 
his efforts that Blue Shield grew from a 
"paper" organization to the largest Blue 
Shield plan in the United States, serving 
all of Pennsylvania. 

He was a tireless worker and a good 
physician. He will be missed by his many 
patients and friends as well as by his as- 
sociates at Blue Shield. 

Dr. Daugherty is survived by his wife 
and three sons, Richard M., Ronald M. 
and the Reverend Robert M., and also by 
a sister, Mrs. Clarence E. Ulrich, and a 
brother, J. Dwight Daugherty, fk.d., of 
Kutztown, Pennsylvania. 



173 



Memoir of John Evan Davis, Jr. 
1908-1968* 

By BALDWIN L. KEYES, m.d. 



BORN in Ashland, Pennsylvania, on 
April 18, 1908, John Evan Davis, Jr., 
completed high school there and 
went on to Pennsylvania State College for 
his Bachelor of Science degree in 1930. He 
entered Jefferson Medical College and ob- 
tained his Medical Doctorate in 1933. 

After an internship in the Cooper Hos- 
pital of Camden, he was appointed to the 
staff of the New Jersey State Hospital in 
Trenton, and quickly became Chief of 
Men's Service. 

In 1941, Dr. Davis was called to active 
duty in the Army as a Reserve Officer and 
eventually became Chief of Neuropsychiatry 
at Stark General Hospital, in Charleston, 
South Carolina, where he served as Colonel 
until 1946. 

After the War he took graduate work at 
Columbia University in New York, Rutgers 
University in New Jersey, and The Research 
Institute in Illinois. He then returned to 
Trenton State Hospital as Clinical Director. 

In 1948, he was called to Washington, 
D. C, to the headquarters of the Veterans 
Administration to organize and direct their 
Psychiatric Out-patient Services throughout 
the country. 

When the Eastern Pennsylvania Psychi- 
atric Institute became a fact in 1950, Dr. 
Davis was promptly selected to become the 
Medical Director of this important institu- 
tion in Philadelphia to carry on treatment, 
research and training programs. 

During his eight years as Director of this 
Institution, his accomplishments were so 
recognized throughout the country that he 
received many offers for state and national 

* Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



opportunities, but he remained here 
through his interest in the work being done 
in Pennsylvania. 

Meanwhile, among his many activities, 
Dr. Davis functioned as Chief of the Psychi- 
atric Consultation Service at Philadelphia 
General Hospital and as President of the 
Philadelphia Psychiatric Society. 

He served as Chairman of The Technical 
Review and Program Design while on the 
Executive Committee of the Governor's 
Comprehensive Mental Health/ Mental Re- 
tardation Plan. He was a delegate to the 
White House Conference on Aging. 

In 1958, Governor Leader of Pennsyl- 
vania appointed Dr. John E. Davis, Jr., 
Commissioner of Mental Health and 
Deputy Secretary of Public Welfare. Dr. 
Davis carried this position with such out- 
standing ability that Governor Lawrence, 
and subsequently Governor Scranton, reap- 
pointed him to the same post to continue 
the program he was accomplishing. 

In 1963, Dr. Davis withdrew from public 
service and accepted a Professorship in Psy- 
chiatry at Jefferson Medical College and was 
appointed Associate Head of the Depart- 
ment. 

At Jefferson, in addition to other duties, 
Dr. Davis took over the responsibility for 
the Residents Training Program, where his 
experience with people, and with many hos- 
pitals and with thousands of patients, came 
to an intensely useful focus. 

To list the professional attainments and 
the services rendered by Dr. Davis to his 
state and country would fill many pages, 
for he was extremely active, giving talks 
when called upon all over the country and 
always helping to solve problems and to 



174 



BALDWIN L. KEYES 



175 



modernize psychiatric services in many 
areas. 

It is appropriate that the John E. Davis 
Community Mental Health Center at Jeffer- 
son has been named in his honor. 

While summarizing the career of John 
Davis, we have not touched upon the most 
important factor of all, the man himself. 

As a boy in Ashland, John Davis met a 
girl who stayed close to his heart all of his 
life. He married Margaret Yost while he was 
an intern and she a student at Temple Uni- 
versity. Thereafter, wherever he went, she 
went also. Margaret Davis shared John's 
problems and successes and contributed im- 
measurably to his accomplishments. 

Their lovely daughter, Gwenn, with de- 
grees from Wellesley, Oxford and Michigan, 
and now a professor at Bryn Mawr College, 
has always been a joy, a sustaining factor 



and stimulus throughout the happy, suc- 
cessful life that these people have enjoyed 
together. 

John was a loveable, cheerful fellow; loyal 
to his Welsh ancestry; proud of his family; 
enthusiastic about his work — whatever it 
happened to be; kindly and considerate; and 
never too hurried to listen to those in 
trouble and to help them solve their prob- 
lems. 

Always a gentleman, a physician and a 
true humanitarian. When he slept away 
from us on May 2nd, 1968, we lost one of 
our most valuable people. 

Now and then, as we walk through life, 
we are joined by a warm friend who strolls 
along with us and makes our way happier 
by his presence and richer for the knowing 
of him. . . . 

. . . Such a man was John Evan Davis, Jr. 



Memoir of Samuel Creadick Rhoads 
i 900— 1 968* 

By WARREN S. REESE, m.d. 



DR. Samuel Creadick Rhoads died in 
Doctors Hospital, Coral Gables, 
Florida, on April 10, 1968, after a 
long illness. He was born in Philadelphia, 
Pa., on September 1, 1900, to John Neely 
Rhoads and Anna Driggs Day Rhoads, both 
of whom were members of old Colonial 
families. 

Dr. Rhoads displayed his hardy Colonial 
background and "Amor Patriae" when dur- 
ing World War I he enlisted in the Army as 
a private though still in his teens. 

Following discharge from the Army in 
1919, he entered Temple University where 
he completed pre-medical training and re- 
ceived his M.D. in 1926. He interned at 
the Montgomery Hospital, Norristown, Pa., 
and then specialized in ophthalmology. On 
May 28, 1928, he married Dr. Rebecca Mc- 
Farlane, a graduate of Woman's Medical 
College. 

He was made Assistant Surgeon at the 
Wills Eye Hospital in 1927 and in 1930 be- 
came Ophthalmologist to the Philadelphia 
General Hospital. In 1934 he was appointed 
Instructor in Ophthalmology at the Wom- 
an's Medical College in Philadelphia, con- 
tinuing on the faculty until 1942, becoming 
Associate Professor, Acting Professor and 
finally Acting Head of the Department of 
Ophthalmology. 

In 1 942, his Colonial ancestry again mani- 
fested itself when he discontinued private 
practice, resigned his positions at various 
hospitals and clinics to enter the United 

* Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



States Air Force, serving as Captain in the 
Medical Corps throughout World War II 
and being commended for his performance. 

After World War II, Dr. Rhoads resumed 
the practice of ophthalmology and his as- 
sociation with various hospitals and clinics, 
serving as Visiting Ophthalmologist to the 
Philadelphia General Hospital, Consulting 
Ophthalmologist at Underwood Hospital, 
Woodbury, New Jersey, Wills Eye Hospital 
and the Woman's Medical College Hospital. 

He was a Diplomate of the American 
Board of Ophthalmology, a member of the 
American Medical Association, the Wills 
Eye Hospital Society, the Gloucester County 
Medical Society of New Jersey and the Air 
Force Association. 

Dr. Rhoads was active in the Baronial 
Order of Magna Charta, and was serving as 
a Surety at the time of his death. He also 
held membership in the Sons of the Revolu- 
tion, the Huguenot Society, Military Order 
of the Crusaders, the LuLu Shrine, the 
Union League and the Society of American 
Magicians. 

His hobbies were golf, cabinet wood work, 
and spinning and electroplating of copper. 

Dr. Rhoads is survived by his widow and 
a son, Dr. John M. Rhoads, presently Pro- 
fessor of Psychiatry at Duke University, and 
four grandchildren. 

Those of us who knew Dr. Rhoads will 
remember him as a delightful, retiring, but 
nevertheless hard and conscientious worker 
who for years assisted, and was much de- 
pended upon, by one of the most dexterous 
and ingenious Attending Surgeons at the 
Wills Eye Hospital, Dr. Frank C. Parker. 



176 



Memoir of Reuben Lore Sharp 
1897-1968* 



By THOMAS M. 

DR. Reuben Lore Sharp was born in 
Mullica Hill, New Jersey, on Aug- 
ust 14, 1897. He died on his farm 
in Mt. Holly on October 17, 1968. 

He attended public schools and matricu- 
lated at Dickinson College in Carlisle, Pa. 
During his freshman year, his father, who 
was a practicing physician in Camden but 
who continued to reside with his family on 
a large operating farm in Mullica Hill, died. 
During this crisis, it was necessary for Dr. 
Sharp as the oldest son to leave college and 
take over the management of the farm. This 
was during World War I. His work on the 
farm gave him an automatic draft exemp- 
tion. After he operated the farm for three 
years, arrangements were made for him to 
return to college, where he distinguished 
himself both as a student and as an athlete. 
Football was his special sport and he played 
on the varsity for three years. 

Following graduation, he entered the 
School of Medicine at the University of 
Pennsylvania and then interned at the 
Graduate Flospital. Subsequently, he spent 
two years as an associate of Dr. Henry 
Bockus at the University of Pennsylvania 
prior to opening his own offices in Camden. 
He was promptly appointed to the Cooper 
Hospital Medical Staff and soon after was 
certified by the Board of Internal Medicine. 
Immediately after Pearl Harbor, he en- 

• Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



KAIN, JR., m.d. 

listed in the Naval Medical Corps and was 
appointed senior medical officer of the 4th 
Division, U.S. Marines. He had a distin- 
guished combat record in the South Pacific. 
His naval combat duty was a source of great 
satisfaction to him because he had a keen 
awareness of his duty to his country. In 
1946, he was released from active duty, re- 
turning to his Camden office and Cooper 
Hospital. 

Dr. Sharp was former President of the 
Camden County Medical Society and for 
many years was a trustee of the Medical 
Society of the State of New Jersey. He was 
former Chief of the Department of Medi- 
cine at Cooper Hospital. 

Dr. Sharp is survived by his widow, the 
former Mary Chambers, and four children. 

Dr. Sharp had a large practice, and there 
are few among his patients who will ever 
forget him. He had an innate ability to in- 
spire confidence. He was generally sensitive 
to the health of others, and it was always 
his wont to subordinate himself to the needs 
of the sick people. 

His professional colleagues will remember 
him as a distinguished internist and gastro- 
enterologist. The public will remember him 
as the epitome of honesty, unbending in in- 
tegrity, and always demanding of himself 
that he do the "right" thing as his judgment 
dictated. 

All of us in the Camden area will miss Dr. 
Sharp. 



177 



Memoir of Calvin Mason Smyth, Jr. 
1894-1967* 

By TITO AUGUSTINE RANIERI, m.d. 



CALVIN MASON SMYTH, JR., was 
born in Philadelphia, August 24, 
1894, the son of Calvin Mason Smyth 
and Margretta Slaughter Smyth. He was 
the eldest of four children. His education 
was in Philadelphia, where he attended 
Germantown Academy, earned a B.S. from 
the University of Pennsylvania and was 
graduated in the famous Class of 1918 of 
the School of Medicine. Many members of 
that class attained professorial rank in vari- 
ous fields of medicine. His uncle, Henry 
Field Smyth, was Professor of Hygiene at 
the School of Medicine. 

His marriage to Madeline Williams 
Smyth brought forth two illustrious sons: 
Calvin Mason Smyth, III, of the State De- 
partment of the United States, specializing 
in the Affairs of Latin America and Far East 
Relations, and Thomas Williams Smyth, 
Vice President of Smyth, Akins & Lerch. 
Both young men were wrestling champions 
in the Interacademic League. There are 
now five grandchildren in the lineage. 

After service in the United States Army 
Medical Corps in World War I, he was an 
intern and surgical resident at the Hospital 
of the University of Pennsylvania under the 
Professorship of John B. Deaver. In 1920 he 
was appointed Instructor in Surgery at the 
Medical School and the same year to the 
original faculty of the Graduate School of 
Medicine as Instructor in Surgical Research. 
He progressed through academic levels to 
Professor in 1952 and Emeritus Professor in 
1961. In his formative years, he was Profes- 
sor of Physiology at the Philadelphia Col- 

* Read before The College of Physicians of Phila- 
delphia, 9 October 1968. Prepared and published at 
the request of the Council of The College of Phy- 
sicians of Philadelphia. 



lege of Pharmacy. His vast knowledge of the 
Polyherbalists was fascinating. 

Dr. Smyth was associated with Dr. Damon 
B. Pfeiffer and was co-author of many surgi- 
cal treatises. He was affiiliated with many 
hospitals in the metropolitan area of Phila- 
delphia. He served at the Methodist Hos- 
pital (1919-1950) as Chief of Surgery (1932- 
1950) and at the Woman's Hospital. In 
1953, he became Surgeon-in-Chief of the 
Abington Memorial Hospital and Director 
of the Pfeiffer Clinic, posts from which 
he retired in 1963. 

He was Consultant in Surgery to the 
United States Naval Hospital, Philadelphia, 
and a Consultant to the Surgeon General of 
the Army. He made a survey of the medical 
facilities of the United States Army in 
Europe in 1953 and in the Asian Theater of 
Operations in 1956. He was retired as Briga- 
dier General in the United States Army 
Medical Corps Reserve. 

He was a member of the Philadelphia 
County Medical Society, the Medical Society 
of the State of Pennsylvania, the American 
Medical Association; a Fellow of the Ameri- 
can College of Surgeons, American Surgical 
Association, Philadelphia Academy of Sur- 
gery, The College of Physicians of Phila- 
delphia, Societe Internationale de Chirurgie 
(Brussels), American Association of Uni- 
versity Professors, Eastern Surgical Associa- 
tion and Society for Surgeons of the Ali- 
mentary Tract. He was a member of the 
Society of the Sigma Xi, Phi Kappa Psi 
Fraternity (College) and Phi Alpha Sigma 
(Medical), Society of the Friendly Sons of 
St. Patrick and Union League of Phila- 
delphia. 

Dr. Smyth edited many books on surgery, 
one a revision of Bickham's Operative Sur- 



178 



MEMOIR OF CALVIN MASON SMYTH, JR. 



179 



gery, Vol. VIII, 1932, another Surgical 
Treatment, and three volumes by Warbasse, 
1937. Also, he was the author of numerous 
chapters and many articles in surgical litera- 
ture. This work and duties led him directly 
to his second consort, Marguerite Schlegel. 
He affectionately preferred to call her 
Martha who, like the Biblical figure, per- 
formed her cheerful chores. This charming 
lady prepared the voluminous manuscripts, 
and she was his constant companion at meet- 
ings, on his tours of duty, lecturing and 
examining. 

When the American Board of Surgery 
was formed in 1937, he was a founder; he 
was active in the organization and prepara- 
tion of the first examinations. He was closely 
associated with Doctor J. Stewart Rodman 
in the Secretarial Office and became Vice 
Chairman 1951-53. This is important as a 
part of the history of surgery in the United 
States. The many Diplomates of the Board 
who have gone through the rigorous exami- 
nations for certification will recall their 
state of anxiety. Despite the fact that he 
examined more young surgeon candidates 
than any other member of the Board, his 
great tact and understanding in dealing 
with their problems brought admiration for 
his unflinching honesty and fairness. His 
efforts were a labor of love and he was loyal 
to the ideals and objectives of improving 
surgical training in the United States. 

As a Fellow of the Academy of Surgery, 
he was faithful to all its meetings. He was 
Secretary for many years and progressed to 
every office, culminating as its President 
from 1950-52. He stimulated debate and 
controversial dialogue. His discussions were 
eloquent, well-worded and concise, favoring 
constructive criticism. He gave the Annual 
Oration on December 4, 1944, entitled, 
"Graduate Surgical Training in America." 

As a member of the Original Faculty of 
the Graduate School, he became the non- 
pareil in the transition of teaching to gradu- 
ate students in contrast to the undergradu- 
ates. The two-hour round table conferences 



were well-organized with teacher-student 
participation in all phases of the profession. 
He emphasized the importance of adhering 
to routine in the care of patients regardless 
of their social status. While associated with 
Dr. Joshua E. Sweet in the Research Depart- 
ment, he designed the operating table with 
a center trough for experimental surgery on 
animals. 

Following the attack on Pearl Harbor, the 
Surgeon General sent hundreds of neo- 
surgeons to the Graduate School. He and his 
associates participated without honorarium 
in teaching the six-week intensive course. 

The early years of the twentieth century 
saw a great change in undergraduate educa- 
tion, whereas between the two World Wars 
growing improvements in graduate medi- 
cal education, specialty training and branch 
specialties were evolved. It was during this 
era that Dr. Smyth and many senior mem- 
bers of the Academy were architects in 
molding new practice in the decorum of the 
profession and a more cordial relationship 
in sharing medical and surgical manage- 
ment. This was the period in which empha- 
sis was placed in making the "patient safe 
for surgery." Despite his efforts to insure 
that the Science and the Art of Surgery ad- 
just to the changes in social relationship, he 
kept the common touch. It was a pleasure to 
watch a skillful and merciful surgeon exam- 
ine and gently palpate the abdomen of an 
acutely ill patient. 

In 1935, he was the medical consultant for 
the Compensation Labor Laws of the State 
of Pennsylvania which brought uniformity 
in compliance with disability in line of duty 
for the laborer. In 1955, Governor George 
Leader appointed Dr. Smyth as the first 
M.D. to the State Board of Examiners of 
Osteopathic Physicians. He accepted the as- 
signment not for disparagement but to shed 
enlightenment in this competitive profes- 
sion. He organized the modus operandi of 
the examinations and raised the standards 
of the future practicing physicians. 

In his youth, he was associated on the 



180 



TITO AUGUSTINE RANIERI 



stage with Edward Everett Horton and 
William Harrigan with whom he developed 
lifelong friendships. In college he was cox- 
swain of the varsity crew and an accom- 
plished bass-violinist. He proudly displayed 
his active Local 77 Musicians Union Card. 
He was a masterful raconteur which en- 
deared him to many friends. He was the 
stellar attraction at the Annual Meeting be- 
tween the New York and Philadelphia Sur- 
geons. He had the highest faculty of the 
intellect and the finest medium for com- 
munication. 

His death on June 18, 1967, was due to 



the "physician's malady," an acute myo- 
cardial infarction and its sequelae. 

He led a full life as he was devoted to his 
work and his scientific accomplishments. 
Yet he enjoyed the pleasures of life: good 
company, music and conversation. He was 
a great teacher, an investigator of merit and 
a clinical surgeon with skill, sympathy, and 
warmth toward patients. 

The dead live in the memory of the liv- 
ing. Dr. Smyth as a believer of body and soul 
left us the heritage: Live and be prepared to 
die tomorrow; work and learn as to live 
forever. 



Transactions of the Philadelphia 
Neurological Society 

OFFICERS 1969 
President 
Frank A. Elliott, M.D. 

1st Vice President 2nd Vice President 

Henry T. Wycis, M.D. William S. Masland, M.D. 

Secretary Treasurer 
Lawrence C. McHenry, Jr., M.D. Martin Mandel, M.D. 

Editor 
Julina Gylfe, M.D. 

PROGRAMS 1968-69* 



October 4, 1968 

Dedicated to the Memory of 
G. Milton Shy, M.D. 

Memorial to G. Milton Shy, M.D. 

GUNTER HAASE, M.D. 

DISEASES OF MUSCLE 
Degeneration and Regeneration of Muscle. 

Henry Schutta, m.d. 
Type I Muscle Fiber Hypotrophy with Central 

Nuclei. W. King Engel, m.d. and D. C. 

De Vivo 

Glycogen Storage Diseases of Muscles. Lewis P. 
Rowland, m.d. 



Memorial to G. Milton Shy, M.D. 

GUNTER HAASE, M.D. 

Dr. Moore, members and guests of the Society: 
Mrs. Shy has asked me to convey her thanks 
* Published by the Transactions & Studies of The 

College of Physicians of Philadelphia, Vol. 37, No. 

2 (4th Series), October 1969. Waverly Press, Inc. 

Baltimore, Maryland 21202. 

Abstracts received by the editor after 15 July 1969 

are published by title only. 

Reprints: Julina Gylfe, M.D., Editor, 1315 DeKalb 

Street, Xorristown, Pennsylvania 19401. 



to the Philadelphia Neurological Society for 
dedicating this meeting to die memory of her 
husband, Dr. G. Milton Shy. She and her chil- 
dren, Michael and Kathy, have further asked 
me to bring you their warm wishes for a suc- 
cessful meeting. 

Milton Shy was a scholarly man. His con- 
tributions, as an investigator, are well known. 
In the short span of years he was allotted in 
his profession, he gained respect in diis coun- 
try and abroad. The secmence of his appoint- 
ments is testimony to his abilities, as the affec- 
tion of his friends is testimony to his character. 

He was a dedicated and ambitious man. Re- 
sponsibilities came to Milton early. At 32, fresh 
from his training in London and Montreal, 
he became Chief of Neurology at the University 
of Colorado. There was the beginning of his 
great attractiveness as a teacher. His lectures, 
on Thursday evenings, were among the best- 
attended teaching activities of the school. Two 
years later, at 34, Milton accepted the awesome 
position of Clinical Director of the National 
Institute of Neurological Diseases and Blind- 
ness. If he felt diffidence, he did not show it. 
He did not see mountains as obstacles but as 
peaks to be conquered. His enthusiasm and his 
dedication were covenants with success. 



181 



182 



PHILADELPHIA NEUROLOGICAL SOCIETY 



He was a complex man. His loyalties were 
strong, and equally strong were the loyalties his 
associates and students offered him. His wish 
to bring out the best in his pupils could, at 
times, be costly to their sensitivity. Yet, I think 
he was happiest at his rounds and teaching 
conferences. Here, he could bring to bear not 
only his rich clinical knowledge, but also die 
understanding he had gained of the basic sci- 
ences, and if he became convinced that an area 
of the basic sciences was relevant to his labors, 
he set out to master it, and master it he would. 

His intensity of purpose was softened by his 
warmth, his friendship, and by a streak of mis- 
chief. Here was a man whose office walls were 
covered by the foreboding pictures of great 
men, great places, diagrams of complex meta- 
bolic pathways — and by a well used dartboard. 
As was said of Anthony, "His delights were 
dolphin-like, they showed his back above the 
element they lived in" — so we remember George 
Milton Shy. 

Degeneration and Regeneration of Muscle 
Henry Schutta, m.d. 

Biopsies from patients with paroxysmal idio- 
pathic myoglobinuria revealed transverse ne- 
crosis of myofibers, where there is destruction 
of the plasma membrane and subsequent inva- 
sion of the damaged fiber by phagocytes. Cen- 
tral necrosis, where damage is confined to cen- 
tral areas of the myofiber and does not reach 
the plasma membrane, gives rise to necrotic 
vacuoles which are similar to those found in 
other vacuolar myopathies. In the past, these 
vacuoles have been interpreted as dilatations 
of the sarcoplasmic reticulum. This interpreta- 
tion appears to be incorrect since the mem- 
brane bounding the vacuoles is related to the 
T-system, and progression from central necrosis 
to vacuoles can be discerned in the biopsies. 
In acute states, bulbous dilatations of the T- 
system give rise to smaller vacuoles, and these 
are thought to reflet electrolyte disturbance in 
partially damaged muscle. Evidence of regen- 
eration was present in myofibers with trans- 
verse necrosis, where regenerant cell processes 
were present at the periphery of the myofiber. 
It is not certain whether they arise from normal 
parts of the damaged myofiber or whether they 
represent activated satellite cells. These find- 
ings were compared with degenerative changes 



and vacuolar abnormalities in a case of hy- 
pokalemic periodic paralysis. 

Type I Muscle Fiber Hypotrophy with 
Central Nuclei 
W. King Engel, m.d. 
D. C. De Vivo 

A 12-year-old boy with congenital muscle 
weakness was found by histochemistry of his 
muscle biopsy to have type I muscle fiber hy- 
potrophy with central nuclei. Details of his 
clinical findings, as well as histochemical and 
electro-microscopic studies of his muscle biopsy, 
were presented. A comparison was made with 
experimental attempts to reproduce this condi- 
tion. The pathogenesis was speculated upon in 
the light of current information on the signifi- 
cance of histochemical types of muscle fibers. 

Glycogen Storage Diseases of Muscle 
Lewis P. Rowland, m.d. 

The glycogen storage diseases are rare but 
important beyond their numbers, for they are 
the first inherited diseases of muscle in which 
die biochemical abnormality is known. Because 
the symptoms differ depending upon which en- 
zyme is deficient, these diseases provide infor- 
mation about the functional importance of 
different steps of the metabolic pathway. Im- 
portant problems remain, however. The precise 
relationship between the biochemical abnormal- 
ity and symptoms has been difficult to eluci- 
date. Atypical syndromes associated with specific 
enzymatic defects have been found, and in some 
cases more than one enzyme seems to be af- 
fected. This review attempted to elucidate the 
significances of these problems. 

November 1, 1968 

CLINICAL CASE REPORTS 

Cerebral Aneurysm Following Spontaneous Ca- 
rotid Occlusion. Marvin E. Jaffe, m.d. 
and Lawrence C. McHenry, Jr., m.d. 

Respiratory Arrest from Seizure Discharges in 
the Limbic System. Dewey A. Nelson 
m.d. and Charles D. Ray, m.d. 

Prevention of Post-herpetic Neuralgia. Frank 
A. Elliott, m.d. 

Management of Brain Swelling Through Con- 



PROGRAMS 1968-1969 



183 



tinuous Recording of Intracranial Pressure. 
T. W. Lancfitt, m.d., N. F. Kassell, m.d. 
and S. S. Lyness, m.d. 

Cerebral Aneurysm Following Spontaneous 
Carotid Occlusion 
Marvin E. Jaffe, m.d. 
Lawrence C. McHenry, Jr., m.d. 

Cerebral aneurysms have been noted to en- 
large, and new cerebral aneurysms to occur, 
subsequent to carotid artery ligation as a treat- 

I ment for aneurysms. However, symptomatic 
, cerebral aneurysm formation is not a reported 
: complication of spontaneous or atherosclerotic 

carotid artery occlusive disease, nor has it been 
i reported as a significant accompaniment of ad- 
• vanced cerebrovascular disease. This is not due 
to failure to search for them, since our group 
and many others as well have done large num- 
bers of angiograms in individuals with carotid 
; artery occlusive disease. 

A case is reported of a 79-year-old Negro fe- 
. male who developed a symptomatic right in- 
i ternal artery aneurysm 10 years after suffering 
a stroke due to a left internal carotid artery 
occlusion. She subsequently died of an acute 
subarachnoid hemorrhage. 

We presented this case as both the first re- 
ported symptomatic carotid artery aneurysm af- 
ter spontaneous carotid artery occlusion, and 
. also for the value it has in pointing out the 
likelihood that developmental vascular anom- 
alies rather than acquired degenerative changes 
are the substrate upon which saccular aneu- 
rysms occur. Hydraulic and hemodynamic fac- 
tors alone are insufficient to cause aneurysms. 

Respiratory Arrest from Seizure Discharges 
in the Limbic System 
Dewey A. Nelson, m.d. and 
Charles D. Ray, m.d. 

Since 1899, when Hughlings Jackson first de- 
scribed respiratory arrest as part of an un- 
cinate fit, a large body of experimental evidence 
has shown that respiratory arrest occurs when 
a number of structures in the cerebral hem- 
isphere are stimulated. The respiratory arrest 

I I is usually in expiration and occurs when the 
following structures are stimulated: posterior 

I lateral frontal cortex, inferior medial temporal 
cortex, anterior insular cortex, anterior cingu- 



late gyrus, amygdala, uncus and fornix. The 
longest reported respiratory arrest from cortical 
stimulation, to date, has been for 56 seconds. 

A depth probe stimulation study was per- 
formed on a 13-year-old girl, who from the age 
of seven had uncontrolled generalized and psy- 
chomotor seizures. One depth stimulation study 
revealed rhythmic 20 to 40 second after-dis- 
charges when a narrow 6 mm. zone near the 
center of the left amygdaloid nucleus was stim- 
ulated. Arrest occurred in inspiration when the 
stimuli were applied at the height of inspiration; 
similarly, stimulation at the height of expira- 
tion produced expiratory arrest. 

A second patient, a 50-year-old physician, 
developed generalized and temporal lobe seiz- 
ures at the age of 20. At the age of 12, he suf- 
fered an electrical shock injury, wherein the 
current entered the body through the right 
thumb and exited dirough the left temporal 
region. The patient has an EEG spike focus in 
the left mid-temporal region. The patient was 
found cyanotic and apneic in bed at home, after 
he had gotten into bed because of feelings of 
extreme fatigue. Several interesting EEG trac- 
ings were made during these periods of apnea. 
One of these revealed a low voltage tracing 
with spindle-like forms of 6 to 14 per second 
frequency. Another revealed a slow, disorga- 
nized tracing with sharp wave discharges em- 
anating from a wide region over the left fronto- 
temporal region. Because of a history of tem- 
poral lobe injury and of psychomotor seizures, 
and because these episodes of arrest cannot be 
ascribed to a prolonged convulsion with mus- 
cular exhaustion, or to the ingestion of some 
drug, we have concluded that these respiratory 
arrests represent some type of seizure phe- 
nomenon. There are several reservations about 
this hypothesis: 1., Experimental stimulation of 
limbic structures has produced arrest for only 
a minute or less whereas this patient has been 
in arrest up to 30 hours; 2., Delayed brain stem 
lesions from electrical shock injury are known 
to occur; 3., There are no clinical reports of 
similar type to confirm these observations. 

Prevention of Post-herpetic Neuralgia 
Frank A. Elliott, m.d. 

Post-herpetic neuralgia has been reported to 
occur in 30% of patients over 40 and in 50% 
of patients over 60. By contrast, post-herpetic 



184 



PHILADELPHIA NEUROLOGICAL SOCIETY 



neuralgia did not occur at all in 64 personal 
cases of shingles treated by the administration 
of high doses of prednisone within the first 
seven days of the appearance of the rash. The 
average age of the group was 64 years. The 
facial paralysis of geniculate herpes recovered 
in two to three weeks. Controls fared less well. 
The treatment, its rationale, and its complica- 
tions were discussed. 

Management of Braiti Swelling through Contin- 
uous Recording of Intracranial Pressure 
T. W. Lancfitt, m.d., N. F. Kassell, m.d. 

AND S. S. LYNESS, M.D. 

Cerebral swelling is a common cause of death 
following head injury, cerebrovascular accidents, 
and intracranial surgery. The primary aim of 
treatment (hypertonic solutions, hypothermia, 
steroids, hyperventilation) is to reduce brain 
bulk. The only reliable criterion for estimating 
the degree of brain swelling and the result of 
therapy is intracranial pressure. We have re- 
corded intracranial pressure continuously fol- 
lowing craniotomy in 85 patients. A catheter was 
inserted into the subdural space at the comple- 
tion of the operation and attached to a trans- 
ducer and polygraph in the Intensive Care 
Unit. The earliest sign of cerebral swelling is 
a gradual rise in intracranial pressure and, of 
equal importance, fluctuations in intracranial 
tension from normal to values as high as 60 
to 80 mm. Hg. These pressure waves are char- 
acteristic of brain swelling and intracranial 
hypertension, irrespective of the cause. Clinical 
signs at the peak of the pressure wave include 
headache, vomiting, and increased neurologi- 
cal deficit, but frequently there is no change 
in the patient's clinical status. Between pres- 
sure waves, intracranial tension remains ele- 
vated, and, ultimately, a terminal pressure 
wave occurs. Intracranial pressure rises to die 
level of the blood pressure and cerebral blood 
flow is abolished. The terminal pressure wave 
is a common cause of rapid deterioration and 
deadi in patients with a space-occupying lesion 
or brain swelling. Miniature, solid-state trans- 
ducers are now available for measurement of 
intracranial pressure. A small transducer can 
be inserted into the intracranial space through 
a twist drill hole in the skull, in order to moni- 
tor patients with severe head injury and strokes, 



and the procedure can be carried out in the 

Emergency Ward. 

December 13, 1968 

THE BORDERLAND OF NEUROLOGY 
AND PSYCHIATRY 

Electrophysiologic Studies of Mental Disorder. 
Charles Shagass, m.d. 

Neuropharmacology of Hallucinogenic Drugs. 
Georce B. Koelle, m.d. 

Some Thoughts on the Limbic System. Joel 
Elkes, m.d. 

Electrophysiological Studies of Mental Disorder 
Charles Shagass, m.d. 

The idea that deviant neurophysiology must 
meditate deviant behavior is generally accepted, 
but psychiatrically relevant neurophysiological 
indicators have been hard to define. EEG find- 
ings in "functional" mental disorders have been 
disappointing, although cautious optimism is 
being generated by approaches applying com- 
puter methods. The technique of recording 
sensory evoked responses by "averaging" has 
also yielded encouraging results in recent years. 

This presentation reviewed some of the main 
findings obtained in our research program 
which, for nearly a decade, has attempted to 
establish psychiatric correlates of evoked re- 
sponse characteristics. As data have accumulated, 
it has become clear that many factors, such as 
age, sex, drugs, and state of alertness, can in- 
fluence evoked responses. Inconsistent results 
are probably attributable to imperfect control 
over such factors. One finding has been con- 
sistent in our own studies and those of odiers: 
recovery function, as measured by applying 
paired "conditioning" and "test" stimuli, is 
reduced in psychiatric patients. Furthermore, 
in current studies, we are finding that the 
orderly relationship between "conditioning" 
stimulus intensity and "test" responsiveness 
present in normals is virtually absent in most 
schizophrenic patients. This suggests disordered 
balance between "inhibitory" and "facilitatory" 
processes in die patients. 

Another new area of considerable interest 
concerns EEG-evoked response relationships 
and their behavioral correlates. We have re- 



PROGRAMS 1968-1969 



185 



cently found that superior perceptual perform- 
ance is associated with greater EEG-evoked 
response amplitude concordance. Psychopadio- 
logical correlates of such concordance variability 
are being investigated. 

Neuropharmacology of Hallucinogenic Drugs 
George B. Koeixe, m.d. 

Hallucinogenic drugs probably act primarily 
in sites of the subcortical limbic system to pro- 
duce their characteristic effects of hallucina- 
tions, diffuse anxiety, and sympathetic hyper- 
; tonia. It is likely that they do so by modifying 
synaptic transmission through adrenergic or 
serotoninergic padiways at these levels. Of pri- 
mary interest is the possible relationship of 
the actions of the hallucinogenic agents to bio- 
chemical abnormalities in the etiology of natu- 
rally occurring psychoses. 

February 7, 1969 
NEURORADIOLOGY AND BLUSHING 

Tumor and Blushes. Mark M. Mishkin, m.d. 

Inflammatory Diseases and Blushes. Norman 
Leeds, m.d. 

Occlusive Disease and Blushes. Herbert Gold- 
berg, m.d. 

Tumor and Blushes 
Mark M. Mishkin, m.d. 

Serial angiography in at least the AP and 
lateral projections is necessary in order to eval- 
uate and differentiate various types of tumors. 
With good quality angiography, correct predic- 
tion of histologic types of vascular tumors 
should be achievable as often as 75% of the 
time. Differentiation of benign from malignant 
lesions is achievable more often than that. 

Vascular lesions fall into four groups: 1., 
meningioma; 2., astrocytoma grades III or IV; 
3., metastasis, and 4., other. The general charac- 
teristics of a vascular tumor are divided into 
two major categories: a., morphologic and b., 
dynamic. Under morphology we find 1., en- 
larged afferent arteries; 2., neovasculature; 3., 
"blush" or "stain"; 4., enlarged and/or early 
filling veins. Under the dynamic characteristics 
are 1., faster circulation through the tumor — 



usually malignant; 2., normal circulation — usu- 
ally benign. 

Meningiomas are usually highly vascular, hav- 
ing a double blood supply from the internal 
and external carotid system, which is pathog- 
nomonic. Characteristically the vessels are seen 
to radiate from a bony point. 

In those tumors demonstrating rapid flow of 
blood into die venous circulation we can make 
a diagnosis of malignancy, either glioma or 
metastasis. These tumors more often drain into 
the deep veins. Gliomas need not be space-tak- 
ing even when they are highly vascular. Oc- 
casionally the grade II astrocytoma can be 
diagnosed because of its entrapment of vessels 
supplying it, these vessels sometimes being en- 
larged even though no tumor stain or early fill- 
ing vein is present. 

The metastases also demonstrate rapid flow. 
The tumor stain starts a little later and fades 
more quickly. Obviously the presence of multi- 
ple lesions makes tliis diagnosis more definite. 
Unfortunately, it is not unusual for metastasis 
to be indistinguishable from gliomas. 

In the posterior fossa, two highly vascular 
and usually benign lesions are present. These 
are the cerebellar hemangioblastoma and the 
chemodectoma. Both of drese show very rapid 
venous shunting as well as an intense tumor 
stain. The hemangioblastoma is not infrequently 
cystic with a mural nodule representing the 
highly vascular component. 

Differentiation from arteriovenous malforma- 
tions can at times be difficult since the dynamics 
are similar to that of a malignant tumor. 
However, the arteriovenous malformation lacks 
the disorganized neovasculature of the glioma 
and is often nqn-space-taking since it is fre- 
quently accompanied by focal atrophy sec- 
ondary to the shunting and resultant "steal." 

Inflammatory Diseases and Blushes 
Norman Leeds, m.d. 

In a review of 27 patients with inflammatory 
diseases of the brain, hypervascular patterns 
were observed in 12. There are three different 
causes for the hypervascular patterns. In the 
first group, the blush is a result of loss of auto- 
regulation with anoxic vasodilatation of arteries 
at the margins of the lesion and shunting of 
blood with early filling of the veins. The veins 
filled are the normal veins in the area. This 



186 



PHILADELPHIA NEUROLOGICAL SOCIETY 



type of abnormal vascular pattern is observed 
at the periphery of the lesion and occurred 
in five patients. 

The second abnormal pattern is a blush 
seen about the margin of the lesion in four 
patients and represents neovascularization 
within die capsule about an abscess. The blush 
is non-uniform, homogenous, circumscribes the 
lesion, and is of long duration persisting from 
the late arterial through the venous phase. This 
should be distinguished from a pseudocapsule 
which may be seen in abscesses and actually 
represents compression of brain tissue by the 
mass. This type of blush is not uniform, less 
homogenous, and of short duration. 

The third type of abnormal vascular pattern 
is tint observed secondary to a reactive hypere- 
mia that develops locally in the brain as a re- 
sponse to an inflammatory lesion. In two pa- 
tients, there was vasodilation of large arteries 
supplying the area of involvement and in one of 
these patients there was a transient blush with 
prominent draining veins. In the other patient, 
there was premature filling of subcortical tem- 
poral veins. In die third patient, vasodilatation 
of arterioles as well as capillary vasodilatation 
was observed. This small vessel dilatation ac- 
counted for the vascular blush observed. These 
three patients all had varieties of encephalitis. 

Occlusive Disease and Blushes 
Herbert Goldberg, m.d. 

The hyperemic blush observed in many pa- 
tients following a cerebral infarction is re- 
lated to a loss of normal autoregulation in and 
around the damaged area of the brain. With 
autoregulation abolished in drese regions, the 
normal vasoconstrictor tone is lost in the arteri- 
olar bed. This results in a reduction in the 
local vascular resistance and generally a higher 
flow through this vascular bed, as long as the 
local arteriolar pressure head is not reduced 
due to occlusion of the supplying artery. Angio- 
graphically, this pathophysiological alteration in 
local cerebral hemodynamics is evidenced by a 
greater volume of contrast passing rapidly 
through die brain tissue into early-appearing 
normal regional veins. The hyperemia is located 
throughout the infarcted area when there is 
adequate primary or collateral circulation pres- 
ent. It is located on the periphery if the in- 



farcted tissue remains ischemic at the time of 
angiography. 

The angiographic characteristics of die blush 
consist of I., its localization primarily within 
the cortex, 2., a punctate arteriolar dilatation, 
3., a uniform capillary cortical stain, 4., a rapid 
disappearance of the blush with early filling of 
normal regional veins. The blush may be local- 
ized to a single convolution or may be more 
extensive, covering die entire vascular distribu- 
tion of a major cerebral branch. Very frequently, 
no occlusions are demonstrated which may be 
due to either a previous embolic thrombus, 
which has dissolved, or secondary to an hypoxic 
episode from a period of relative or absolute 
hypotension in a hypertensive patient with 
cardiovascular disease. 

The blush generally does not persist for more 
than 2 to 3 weeks following the infarction be- 
cause autoregulation returns in the damaged 
areas. Follow-up angiography after two weeks 
will reveal either complete clearing or a marked 
resolution in the hyperemic reaction when it is 
secondary to loss of autoregulation following 
cerebral infarction. 

March 7, 1969 

THE INFLUENCE OF NOXIOUS AGENTS 
ON THE DEVELOPING NERVOUS 
SYSTEM 

The Influence of Malnutrition on the Develop- 
ing Nervous System. Donald J. Fishman, 
m.d. 

Studies on Genetic Acid Mucopolysaccharidosis, 
Type 3. M. Harold Fogelson, m.d. 

Calcium Exchange between Blood, Brain, and 
CSF. Leonard J. Graziani, m.d. 

Metabolic Abnormalities in Subacute Necrotiz- 
ing Encephalomyelitis. Warren Grover, 

M.D. 

Studies on Genetic Acid Mucopolysaccharidosis, 
Type 3 
M. Harold Fogelson, m.d. 

The Genetic Mucopolysaccharidoses (genetic 
MPS) are inherited disorders of connective 
tissues associated with increased tissue accumu- 
lation and urinary excretion of acid glycos- 



PROGRAMS 1968-1969 



187 



aminolycan (GAG — acid mucopolysaccliarides). 
Currently, there are six types separated by clini- 
cal, genetic, radiographic and biochemical evi- 
dence. All disorders are inherited as autosomal 
recessive traits except MPS II, which is inherited 
as an X-linked recessive trait. 

MPS I or Hunter's Disease is the prototype 
disorder whose features are seen in a variable 
extent in the other disorders. MPS II or Hun- 
ter's Disease differs from MPS I in having no 
corneal opacities and less rapid deterioration 
of mental and physical abilities. 

Type III MPS or Sanfilippo Disease was de- 
scribed in 1963 for a group of children whose 
gross features are reminiscent of the other types 
but whose somatic changes arc minor in com- 
parison to the severe degree of mental retarda- 
tion. These children have slightly retarded 
development early but learning plateaus by 3 
years. They almost never achieve speech; those 
milestones diat are gained are subsequently lost. 
Their behavior deteriorates and the children be- 
come withdrawn, stubborn and excessively 
sleepy. 

Physical examination demonstrates little: 
corneas are clear; joint restriction is minimal; 
hepatosplenomegaly is not consistently found; 
no cardiac problems have been noted; head is 
scaphocephaly and large with frontal bossing 
in late stages; neurological examination elicits 
increased tendon reflexes and abnormalities of 
movement — suggesting athetosis. Seizures are 
frequent. Death occurs by die end of the second 
decade due to increased neurological deteriora- 
tion, inanition and pneumonia. 

Urinary findings have revealed increased 
quantities of glycosaminolycan — specifically hep- 
aran sulfate widi lesser quantities of Dermatan 
Sulfate (Chondroitin sulfate B). As with other 
genetic MPS, bone changes are usually pro- 
nounced in those disorders excreting Dermatan 
sulfate, while mental retardation occurs in those 
disorders excreting heparan sulfate as a major 
GAG. 

We recently have been attempting to modify 
urinary excretion of GAG in Sanfilippo patients 
by salicylates. Among its functions, salicylates 
interfere with PAPS sulfation and have been 
shown to retard organization of connective 
tissue in its final form. In three patients who 
were discovered at a late stage, that is, after 
two years when changes had already proceeded 



at an inexorable rate, we administered salicyl- 
ates in doses of 100 mgm./kg. — a similar range 
to that used on rheumatic fever patients. Our 
results suggest that there occurs a twofold in- 
crease of urinary acidic (. U. excretion on short 
term administration of 7 days. This increased 
excretion was not on die basis of renal creatinine 
clearance, which remained constant. 

Calcium Exchange between Blood, Brain, 
and CSF 
Leonard J. Graziani, m.d. 

Toxic effects of altered serum calcium con- 
centrations on die central nervous system have 
been noted in infants, children and adults. 
Animal experiments have demonstrated pro- 
found behavioral effects with changes in the CSF 
concentration of calcium, related to altered 
electrical excitability of nervous tissue. In addi- 
tion, the calcium level in the CSF tends to re- 
main within a limited range, independent of 
the level in the serum, and the normal CSF to 
serum ratio of approximately 0.5 is not main- 
tained in man or dog with hypo- or hyper- 
calcemia. 

In acute experiments, calcium exchange was 
measured in anesdietized cats during steady- 
state ventriculocisternal perfusions. When Ca 45 
was added to the perfusate, the efflux coefficient 
was independent of CSF Ca concentration, in- 
dicating passive diffusion. About one-third of 
this isotope was recovered in brain tissue and 
was localized to areas immediately adjacent to 
the CSF pathway. When Ca 15 was given intra- 
venously during ventriculocisternal perfusion, a 
component of the influx coefficient from blood 
was reciprocally related to serum calcium con- 
centration consistent with an active or carrier- 
mediated process; another smaller component of 
the coefficient was constant, consistent with 
passive diffusion. 

When oubain was added to the perfusate, both 
CSF production and Ca influx was reduced, 
suggesting an influx component related to CSF 
formation. However, when Diamox was added 
to the perfusate, a component of Ca influx con- 
tinued independent of the reduced CSF forma- 
tion. About one-third of the Ca entering CSF 
was from adjacent brain. In hypoparathyroid 
animals influx of Ca 4= from blood to CSF was 
reduced to about one-half that of normal ani- 
mals due to a decreased active component, al- 



188 



PHILADELPHIA NEUROLOGICAL SOCIETY 



though Ca influx from brain to CSF was un- 
changed. Ca 46 uptake by brain in cats and 
immature and adult rats indicates that the rate 
of calcium exchange between blood and brain is 
much less than between blood and CSF and is 
related to maturity, animal species, region of 
the brain and blood calcium concentration. 

Metabolic Abnormalities in Subacute Necrotiz- 
ing Encephalomyelitis 

Warren Grover, m.d. 

The clinical and biochemical abnormalities 
in a patient with subacute necrotizing encephal- 
omyelitis were serially evaluated after a sibling 
expired with the same disorder. The appearance 
of fundal abnormalities as well as lactic acidosis 
were noted before the development of signifi- 
cant clinical involvement. In contrast to previ- 
ous enzyme assays, higher levels of pyruvate, 
carboxylase, and phosphoenolpyruvate carbox- 
ykinase levels were found. A review of the 
available literature, as well as evaluation of the 
second patient, suggests that this syndrome may 
result from impairment of more than one 
enzyme site in glycolytic pathways. 

May 9, 1969 

CURRENT DEVELOPMENTS IN THE 
TREATMENT OF PARKINSON'S 
DISEASE 

I. Biocliemistry of Parkinsonism. Stanley Fahn, 

M.D. 

1 1 . L-Dopa and Parkinson's Disease. 

A. Experiences in Treatment of Parkinsonism. 

Gabriel A. Schwarz, m.d. and Lewis 
P. Rowland, m.d. 

B. A Clinical Trial. Edgar J. Ken yon, m.d., 

Richard A. Chambers, m.d. and 
Leonard Katz, m.d. 

C. Evaluation of 38 Treated Patients. Jack O. 

Greenberg, m.d. 

III. Role of L-Dopa in the Surgical Treatment of 
Parkinson's Disease. Henry T. Wycis, m.d., 
E. Spiegel, m.d., G. Kalett, m.d. and 
W. Cunningham, m.d. 



Biochemistry of Parkinsonism 
Stanley Fahn, m.d. 

The use of L-Dopa (L-3,4-dihydroxyphenyl- 
alanine) in the treatment of Parkinson's disease 
is a classical example of a direct therapeutic 
benefit derived from the study of basic neuro- 
chemistry, rather than an empirical discovery 
of a new drug. The historical aspects of the 
scientific discoveries in this area were reviewed. 
Also discussed were the metabolism and function 
of dopamine in the basal ganglia. The relation- 
ship between degeneration of the substantia 
nigra and the reduction of dopamine in the 
neostriatum can be explained on the basis of a 
dopaminergic nigro-neostriatal pathway. The 
evidence supporting the existence of this path 
and the evidence that reduction of dopamine is 
responsible for many of the clinical features of 
parkinsonism were also examined. 

After more dian 150 years after James Par- 
kinson's original description of this disease, we 
are now beginning to unravel some of its mys- 
tery. Neuropathological studies and experi- 
mental lesions in animals left out many pieces 
of the puzzle which the chemists and physiol- 
ogists are filling in. An interesting sideline of 
Dopa therapy is the recognition of the role of 
dopamine in the production of choreiform 
movements. The role of Dopa, anticholinergics 
and phenothiazines in the treatment or causa- 
tion of parkinsonism and chorea can possibly 
be explained on the basis of transmitter action 
on striatal neurons. Despite these recent ad- 
vances the loss of pigment, neuronal degenera- 
tion and the presence of Lewy bodies in the 
substantia nigra are not yet understood. 

Experiences in Treatment of Parkinsonism 

Gabriel A. Schwarz, m.d. and Lewis P. 
Rowland, m.d. 

This report was limited to results with our 
first 36 patients who had an "adequate" dosage 
of L-Dopa for more than one month. We have 
accepted any patient in whom the diagnosis of 
parkinsonism has been made. Consequently, 
many of our patients have been severely in- 
capacitated and bedfast, demented, or ill with 
disturbances of other systems. A number of our 
patients have had various kinds of surgical 
procedures for relief of parkinsonism symptoms. 

Age at onset of parkinsonism ranged from 32 



PROGRAMS 1968-1969 



189 



to 76 years. Age at start of treatment with L- 
Dopa was from 38 to 80 years. Only 9 of our pa- 
tients were under 55; while 14 were over 70 
years of age. Twenty-five patients had the dis- 
ease between 1-5 years; 15 between 5-10; 6 be- 
tween 10-15 years and 4 between 15-20 years. 
Of our first 51 patients, 3 stopped L-Dopa. One 
stopped because of the development of a rash, 
lethargy, tachycardia, nausea, and malaise; one 

I could not afford to continue; and one had no 
improvement at safe dosage. 

Results of treatment with L-Dopa (36 pa- 
tients): in 2, the disease progressed; in 4, no 

, change; 2, slight improvement; 9, significant 
improvement; 11, marked improvement; 8, 

, return to normal or almost normal. Four of 
our patients have died, all because of respiratory 
complications associated with dysphagia. 

Five to 21 grams of L-Dopa per day have been 
used. In general, dosages of more than 8 grams 
per day induced postural hypotension and/or 
psychoses so that this dosage could not be 
maintained. Nineteen of our 36 patients re- 
quired 6 grams or less. 

Maintenance dosage was less than 7.5 grams 
per day in all patients. One patient could not 
tolerate any L-Dopa. Most patients required 
4 grams per day before any improvement was 
perceived. A few patients showed persistent 

: gains with remarkably small amounts of L-Dopa 
per day. 

, Stage of disease, degree of dysphagia, tremor, 
rigidity, or ability to arise from a chair, walking 
difficulty, hand agility, or postural stability 

. were found not to correlate well with die degree 
of improvement that occurred. There has de- 
veloped an impression that die presence of 
dysphagia is an unfavorable sign for therapeutic 
response and possibly life expectancy. 

None of our patients showed changes in 
blood counts or special blood studies (BUN, 

I FBS, SGOT, SGPT, alk. phos., PBI). Most 
frequent side effects were gastrointestinal upsets 
— nausea, vomiting, anorexia; next was chorea; 

i \ then orthostatic hypotension; and finally psychic 

I or emotional effects. All of the side effects were 
temporary and reversible. They promptly cleared 
when L-Dopa was stopped or reduced. Invari- 
ably, a careful slow increase in dosage avoided 
a recurrence of side effects. It was our impres- 
sion that the patients who displayed most benefit 
i from L-Dopa developed chorea as a side effect. 



A Clinical Trail 
Edgar Kenton, m.d. 
Richard A. Chambers, m.d. 
Leonard Katz, m.d. 

A double-blind evaluation of L-3,4 dihydroxy- 
phenylalanine (L-Dopa) is currently being con- 
ducted in 20 patients widi Parkinson's disease. 
An additional 10 patients with this disease have 
been started (non-double-blind) on this drug. 
Of the 30 patients, to date 21 have been com- 
pleted of which 9 have shown a dramatic im- 
provement; 3, a marked improvement; 8, a 
modest improvement, and 1 patient, a marked 
worsening of parkinsonism. 

Side effects noted to date are nausea, vomiting, 
orthostatic hypotension, leukopenia, hypomania 
and hyperosmia. In addition, hyperkinesias in 
die form of dystonia, choreo-athetosis and 
grimacing movements have been observed. 

Evaluation of 38 Treated Patients 
Jack O. Greenberg, m.d. 

The results of treatment widi L-Dopa were 
evaluated in 38 patients referred to the Epis- 
copal Hospital with a diagnosis of Parkinson's 
disease from October, 1968, through March, 
1969. Eight patients were markedly improved 
and able to perform all functions of daily 
living. Thirteen patients showed an excellent 
response and were able to perform all functions 
of daily living but still had some signs of Par- 
kinson's disease. Three of these had to be taken 
off the drug for one reason or another. Seven 
patients showed a good response with improve- 
ment in daily functions but still showing obvious 
signs of Parkinson's disease. One of these pa- 
tients had to be taken off the drug later. Three 
patients had a fair response with minimal im- 
provement in functioning and obvious signs of 
Parkinson's disease. Two of these had to come 
off the drug later. Seven patients never showed 
any response. 

Side effects were present in a number of pa- 
tients. Six demonstrated orthostatic hypotension, 
and of these, only one complained of symptoms 
upon standing. Nausea was present in 24 pa- 
tients, vomiting in 14, chorea in 17 patients, and 
in 6 of these the limbs were involved and in 1 1 
the mouth was involved with chewing move- 
ments. Four patients complained of dizziness or 
lighdieadedness and 14 had episodes of con- 



190 



PHILADELPHIA NEUROLOGICAL SOCIETY 



fusion. Eleven patients had hallucinations or 
"bad dreams," five became depressed, 4 were 
anorexic, and 2 developed incessant talking. 

At the time of discharge, the majority of pa- 
tients were taking between 8 and 12 capsules a 
day. At least three patients improved after dis- 
charge from the hospital. Most of the side-effects 
were dose-related and were transitory in nature. 
At the time of the report, no patient still on the 
drug had had any serious lasting side-effects. 

Role of L-Dopa in the Surgical Treatment of 
Parkinson's Disease 
Henry T. Wycis, m.d., E. Spiegel, m.d., G. 
Kalett, m.d. and W. Cunningham, m.d. 

It is well known that relief of bradykinesia or 
akinesia associated with or without rigidity and 
with or without tremor by stereotaxic surgery 
has not been forthcoming. A previous publica- 
tion dealing with an attempt to ameliorate this 
distressing symptom by placing stereotaxic le- 
sions in the caudate nucleus in six cases resulted 
in partial relief in two and a more lasting 
result in a third case. The introduction of L- 
Dopa has offered a useful pharmacological ap- 



proach for the treatment of this disabling feature 
of Parkinson's disease. Since there is a diversity 
of opinion regarding the effects of L-Dopa upon 
tremor, it was decided to treat two groups of pa- 
tients (total 30 patients). 

Group I were those who were surgically re- 
lieved of tremor without any demonstrable 
change of their akinesia; and Group II, non- 
surgical patients with akinesia or bradykinesia 
with rigidity and tremor. All patients were 
hospitalized and were treated with L-Dopa, 4-8 
grams daily. Blood counts, blood sugars, BUN's, 
partial liver profiles, and EKG's were performed 
on admission, at one week, and three weeks 
later at the time of discharge. The gait, the 
speed of flexor-extensor movements of the 
fingers and severity and rate of tremor rhythm 
as well as tests requiring speed and dexterity 
were filmed for exact time intervals before and 
after L-Dopa. Toxicity and side effects were 
filmed for exact time intervals before and after 
L-Dopa. Toxicity and the side effects were re- 
corded. The result in both groups were com- 
pared and were briefly illustrated by a short 
film clip. 



EDITOR'S NOTE 

Two errors appeared in connection with the Memoirs published in the July 
1959 (Vol. 37, No. 1) issue of the Transactions & Studies. 

The memoir of John Arthur Daugherty (1902-1968) was prepared by Allen 
W. Cowley, Sr., not by Edward C. Raffensperger, as printed, or by Victor C. 
Vaughan, III, as listed in the Contents. The memoir with its correct author is 
republished in this issue. 

The author of the memoir of Joseph Howard Cloud (1872-1968) was Victor 
C. Vaughan, III, as printed, not Edward C. Raffensperger, as listed in the Con- 
tents. 

The Editor and Publisher apologize for these errors. 



TRANSACTIONS V STUDIES 

of 

The College of Physicians of Philadelphia 



Volume 37 
(Fourth Series) 




Number 3 
(January 1970) 



Health Care for the 1970's 1 

By JOSEPH T. ENGLISH, M.D. 2 



THE College of Physicians of Phila- 
delphia was born in a time and 
climate of revolution. 
Its first meeting was held on January 2, 
1787 — nine months before another group 
of men, in this same city, were to sign a 
document designed to ". . . form a more 
perfect Union, establish Justice, insure 
domestic tranquillity, provide for the com- 
mon defense, promote the general Welfare, 
and secure the Blessings of Liberty. . . ." 

Eleven years earlier, also in this same 
city, one of the officers present at that first 
meeting of the College, Dr. Benjamin Rush, 
had been among the signers of still another 
document which proclaimed to the world 
that the rights to life, liberty, and the pur- 
suit of happiness were both self-evident and 
inalienable. 

And nine years earlier still, in 1767, John 
Morgan had proposed the idea of a Phila- 
delphia College of Physicians to Thomas 
Penn. Thus, the birth of this enduring in- 
stitution is interwoven with the events, the 
ferment of crisis and change, that produced 
the American Republic. 

1 James M. Anders Lecture XLVIII, The College 
of Physicians of Philadelphia, 5 November 1969. 

2 Administrator, Health Services and Mental 
Health Administration, Department of Health, 
Education and Welfare, 9000 Rockville Pike, 
Bethesda, Maryland 20014. 



The Pennsylvania Packet and Daily Ad- 
vertiser, in its issue of February 1, 1787, 
published the constitution of the newly 
created College. Its declared purposes were: 
". . . to advance the Science of Medicine, 
and thereby to lessen Human Misery, by 
investigating the diseases and remedies 
which are peculiar to our Country, by 
observing the effects of different seasons, 
climates and situations upon the Human 
body, by recording the changes that are 
produced in diseases by the progress of 
Agriculture, Arts, Population, and Man- 
ners, by searching for medicines in our 
Woods, Waters, and the bowels of the 
Earth, by enlarging our avenues to 
knowledge from the discoveries and pub- 
lications of foreign Countries; by ap- 
pointing stated times for Literary in- 
tercourse and communications, and by 
cultivating order and uniformity in 
the practice of Physick." 
Allowing for the impact of time on lan- 
guage, that statement of purpose bears re- 
examination today, nearly two centuries 
later. We are again in a time of ferment, of 
crisis and change. Where do we stand to- 
day: 

In our efforts "to lessen Human misery?" 

In our understanding of "the effects of 
different . . . situations upon the human 
body?" 



191 



192 



JOSEPH T. ENGLISH 



In coping with the changes produced by 
progress in ". . . Population and Manners?" 

In "cultivating order and uniformity in 
the practice of Physick?" 

We have moved through 18 decades. Dur- 
ing the last three of them, the science of 
medicine has advanced unbelievably. Yet 
human misery still surrounds us. In fact, 
the main difference between today's misery 
and that of 1787 is that today we have the 
capability for alleviating it which the found- 
ers of the College did not. We have not yet 
found ways of delivering that capability 
where the misery is greatest. 

In these 18 decades, we have achieved 
some order and uniformity in medical 
practice, viewed in the narrow context of 
what the physician does. We have achieved 
neither order nor uniformity if we view 
medical practice from the outside, in the 
setting of the universe of need. There is 
neither order nor uniformity nor equity of 
access to medical service. There is neither 
order nor uniformity nor efficiency in the 
way the health care system works. 

In fact, these same purposes which the 
founders of The College of Physicians of 
Philadelphia perceived in somewhat dif- 
ferent form and to which they addressed 
their new institution in 1787 are those 
which confront us as we enter the 1970's. 
They are central to the crisis we face in the 
delivery of health care. How shall we apply 
the advances of medical science to the less- 
ening of human misery with equity, effi- 
ciency and dignity? 

The existence of a crisis in the delivery 
of health care is proclaimed in our daily 
newspapers. Our growing population, 
which is also growing more sophisticated 
every day, knows there is a crisis. People 
know about the miracles of modern medi- 
cine. They also know, through experience, 
of the unmet needs in terms of both quality 
and quantity of care available. They 
wonder how the same ledger can contain 
such contrasting entries. 

We in the health professions are becom- 



ing more widely aware of the dark side of 
the ledger. We know: 

That the United States ranks 15th among 
the nations of the world in infant mortality; 

That we are 22nd in life expectancy for 
adult males; 

That nearly half the women in this 
country giving birth in public hospitals this 
year will have had absolutely no prenatal 
care; 

That 22 per cent of the children born of 
these women will be born prematurely; 

That 5 per cent of all children born this 
year in this country will be born mentally 
retarded, and that 75 per cent of those 
mentally retarded children will come from 
urban and rural poverty areas; 

That a poor child born in the United 
States in 1969 has twice the risk of dying 
before his first birthday as would one of 
our children, and four times the risk of 
dying before reaching the age of 35. 

We also know enough to suspect some 
relationships among these facts — between 
lack of prenatal care and infant mortality, 
prematurity and mental retardation, for 
example. The relationships between these 
national data and specific local situations 
are becoming clearer. In a study of the City 
of Chicago in 1963, for instance, there is a 
striking correlation between infant mor- 
tality and premature birth rates and the in- 
come levels of the population. 

Meanwhile, other very relevant facts are 
being added. In the Kenwood section of 
Chicago — a very low income area today — 
there were 42 physicians 20 years ago serv- 
ing a population of about 25,000. Today, 
46,000 people live in Kenwood, served by 
two physicians. 

Nor is this exclusively a problem of the 
urban ghetto. In a county seat town in the 
eastern part of the State of Washington 
there were, just ten years ago, six physicians 
and a good small hospital. Since then two 
have died; one has retired; a fourth has 
moved to Seattle. When one of the two 
remaining doctors decided to follow his 



HEALTH CARE FOR THE 1970's 



193 



colleague to the city, the last one faced the 
fact that he could not operate the hospital 
alone. The population needing care has 
remained relatively stable. The care avail- 
able to them has virtually vanished. 

This example illustrates another signifi- 
cant point. The health care crisis is not 
confined to the poor — for this is a relatively 
wealthy agricultural area. Certainly the 
situation in the ghettos and in the rural 
poverty pockets is the most desperate and 
cries out the most urgently for solution. But 
the crisis is national. It is nation-wide. And 
it is felt to some degree by non-poor as well 
as poor, by suburbanite as well as central 
city-dweller and farmer. 

On July 10, 1969, Secretary Robert Finch 
of HEW and his newly appointed Assistant 
Secretary for Health and Scientific Affairs, 
Dr. Roger Egeberg, presented to President 
Nixon their assessment of the health care 
challenge. The report opened with these 
words: 

"This Nation is faced with a breakdown 
in the delivery of health care unless im- 
mediate and concerted action is taken by 
government and the private sector." 

Those are grave words. They cannot be 
taken lightly, coming from men accustomed 
to dealing with crisis in its most urgent 
forms. The course of health care in the 
1970*s will determine whether or not we 
avert that breakdown. Will we be able to 
take immediate and concerted action, and 
will it work? 

The lessons of the years just past should 
be instructive to us. We have, it seems to 
me, acted upon and exploded two myths 
in the past 20 years. 

The first of these myths was that massive 
investment of money and talent in bio- 
medical research would result in advances 
that would automatically be transmitted 
throughout the health care system to the 
benefit of all. We made the investment. 
The advances came — brilliant advances in 
every field of medical science and technol- 
ogy. But the automatic transmission 



throughout the system did not occur. In- 
stead, the gap between the best in medic ine 
— which rose rapidly — and the medicine 
available to great numbers of our people — ■ 
which did not — became wider. 

The second myth was that the problem 
of access to the best in health care was 
strictly a financial problem. All that stood 
between some 30 to 45 million people and 
the mainstream of American medicine was 
lack of money. If they were given a money 
ticket into the system, we assumed, they 
would then automatically be able to par- 
take of the highest medical excellence. 

This mythology was the subject of in- 
tense debate. But the debate centered on 
how to issue the money ticket, and whether 
it should come from governmental or pri- 
vate sources. Enactment of the Social Secu- 
rity Amendments of 1965, which created 
Medicare and Medicaid, was the outcome 
of this economic and ideological dialogue. 

But the validity of the myth itself was 
scarcely debated at all. Today 76 per cent 
of the greatly increased total federal invest- 
ment in health is devoted to the financing 
of health care — to the issuing of money 
tickets. And today we are learning pain- 
fully that again no automatic, universal 
access to the mainstream of medicine is 
occurring. For millions the mainstream still 
does not flow. There is no one to honor 
properly the tickets they possess. 

The result has been a greatly heightened 
demand — effective demand in the economic 
sense — for high quality health care. This 
demand has placed enormous stress on the 
capacity of the American health enterprise. 

Physicians face greatly increased patient 
loads — sometimes double or triple the load 
they were bearing before. Inevitably this 
strains each physician's capacity to give 
every patient the highest quality care. It 
drives him to increase his charges — in part, 
at least, to protect his own coronary vessels 
by buffering the demand. The sheer weight 
of numbers of patients seeking his attention 
forces him to put those who are seriously 



194 



JOSEPH T. ENGLISH 



ill into hospitals — many of whom might 
have been cared for outside the hospital in 
other circumstances. This, in turn, strains 
the already overtaxed hospital resource. 

Thus, we risk dilution of the quality of 
care. We experience skyrocketing inflation 
in medical prices. We find increasing in- 
equities and indignities in the human rela- 
tionships involved in health service. All of 
these happenings — which are part of the 
potential "breakdown" to which the Secre- 
tary and Dr. Egeberg referred — are the 
products of an unprepared system laboring 
under overwhelming quantitative demand. 

It should not be inferred that the Na- 
tion's investment in biomedical research 
and its more recent investment in the 
financing of care were not important and 
necessary. Research has led and will con- 
tinue to lead to heightened medical capa- 
bility without which the whole medical 
enterprise would wither and die. Medicare 
and Medicaid have knocked down the finan- 
cial obstacle to medical care for millions of 
people who desperately need it. 

Rather, the point is that neither of these 
two investments has solved the basic prob- 
lem of getting good health care to all who 
need it. Standing between them and that 
goal is the capacity of the health care system 
to deliver. 

Later on in their report to the President, 
Mr. Finch and Dr. Egeberg wrote: 

"Our task now as a Nation is to acknowl- 
edge the extreme urgency of the situation, 
to take certain steps to arrest the inflation 
that is paralyzing us, and to put in motion 
initiatives that ultimately will reshape the 
system. This task is obviously not one for 
government alone, although government 
has a major role to play. Much of the 
burden must be taken up by the private sec- 
tor since it has the primary responsibility 
for the delivery of health care." 

The Secretary and Assistant Secretary 
then listed a number of specific responses to 
this crisis. Among these initiatives were a 
number of actions designed to build the 



capacity of our national health resources, 
so that they can respond to the scale of the 
challenge. These responses recognize the 
central fact that governmental action in the 
health care field must, because of the par- 
ticularly local and personal character of 
medical care, have its impact in the com- 
munity. For it is there that doctors and 
hospitals face, every day, the demands of 
serving more people better than ever before. 

There is a great feeling in this country, 
supported by many studies, that our greatest 
need is to develop primary family health 
care. Primary care is the point of entry into 
the system. It is the point where the great 
quantitative need can and should be met. 
Yet what is the nature of primary care in 
this country today? 

For the 46,000 people who live in the 
Kenwood section of Chicago, with two 
physicians, primary care is Cook County 
Hospital which sees one million patients 
per year. For literally millions of people, 
primary care is a long bus ride, two hours 
on a hard bench, impersonal treatment by 
the numbers, perhaps at the end of it a 
referral to another time and place involving 
another bus and another bench. Different 
but also acute problems confront the rural 
and suburban American in pursuit of pri- 
mary care. 

This is not the face of American medicine 
that we like to present to the world. It is 
not the face we tend to talk about when we 
assemble in our medical forums to discuss 
the present and future. In fact, this is an 
important part of the problem. No medical 
institutions exist to whom we can address 
the big questions like "Whose responsibility 
is primary care in the 1970's?" 

The physician, through the institutions 
and organizations he has created, has always 
accepted responsibility for what he does. He 
bears with pride the full weight of respon- 
sibility for his patients, and this is a respon- 
sibility of life and death in the most literal 
sense. But neither he nor his professional 
organizations nor any other institution in 



HEALTH CARE FOR THE 1970's 



1') i 



win so(ici\ has accepted tespoiisibilily tor 
what the physician docs not do — lor the 
"real numbers ol people needing health 
care who arc no one's patients. 

What we urgently need today is a revolu- 
tion in the institutions ol medical caie that 
will cieate new loci ol responsibility. Heir 
in this city, which cut its teeth on revolu- 
tion, ihis should be not a threat but a 
challenge. 

Fhe shape and substance ol these new in- 
stitutions is not yet clear. But it is very 
clear that they must evolve out ol the 
public -pi i\ ate partnership that is now 
being built. Neithei private medicine alone 
nor government alone can do the job. 

Hopeful signs aie beginning to emerge. 
The revolution is already underway. Let 
me cite a few examples. 

When the Federal government estab- 
lished the Headstall program a lew years 
ago, it was seeking to meet head-on the 
problems of poverty's child, Fo meet the 
critical health needs of the Headstart chil- 
dren, one of the great institutions of private 
medicine, the American Academy of Pedi- 
atrics, stepped forward to assume respon- 
sibility. As of the first of this month, 697 
pediatricians are currently at work on 
I leadstai i projee ts, and anothei 272 ai e en 
rolled and reach to be assigned as soon as 
projects get underway. This is private- 
public collaborative effort at its best. 

When government confronted the prob- 
lems of the Watts community in Los 
Angeles, anothei private institution — the 
Medical School of the University of 
Southern California, then under the direc- 
tion of Dr. Egeberg — accepted major re- 
sponsibility for the medical aspects of that 
task in cooperation with the Neighborhood 
Health Centers program of the Office of 
Economic Opportunity. Toda\ 10 OEO 
health projects are actually administered by 
medical schools, another 10 by teaching or 
community hospitals, two by medical 
societies and 3 by group practice organiza- 
tions. In all, nearly half the medical schools 



of the country and some l. r > medic al mk ict its 
are involved in the operation ol Neighbor- 
hood Health Centei projects. 

In Seattle, the Washington State- Medical 
Society and the Medical School of the Uni- 
versity ol Washington are co-sponsoring 
with the Fedei a] govei nmeni a projeel 
designed to take advantage ol a great un- 
tapped source ol medical expertise — return- 
ing medical corpsincn ol the aimed loices. 
Fifteen men with up to 1900 hours of 
formal medical training are now working 
with private physician-preceptors, using 
skills gained in a inilit.ny setting. They 
are caded Medex from the French phrase 
medicin-extension — and the) ma\ be the 
vanguard ol many mole. I wo ol these men, 
incidentally, are now working in that com- 
munit) which had lost almost all its physi- 
cians. 1 he lact that the) are there has 
enabled the- hospital to stay open. 

In a West Oakland slum area, across the 
bay from San Francisco, 50 physicians and 
dentists now serve a community that had 
only live health professionals a lew vcars 
ago. They are there because the West Oak- 
land Health Center is there. The West Oak- 
land Health Center is there because cont- 
inuum residents — all black, none wealthy, 
only a lew high school graduates — studied 
their health needs and found the resources 
and the leverage to meet them. 

More examples could be cited — not 
enough, but an indication that new health 
institutions are evolving, cut tej the measure 
ol the health challenge of the '70s. Each of 
these examples illustrates a dilfcrent kind ol 
public -private partnership. 

By far the greatest share of the increased 
Federal investment in health in the past 
lew years has been on the financing side ol 
the equation. Medicare and Medicaid to- 
gether account for more than three-fourths 
of the $14 billion Federal input in the $53 
billion health industrv. Bv contrast the 
governmental investment in building the 
capacity of the system is verv small. 

Yet several programs, mostly of very 



I'M, 



JOSEPH T. ENGLISH 



recent origin, are now underway with the 
purpose of strengthening capacity by im- 
proving the w;i\s in which health care is 
organized and delivered in the community. 
Most, though by no means all, of these are 
now pulled together in the Health Services 
and Mental Health Adminisli ation, or 
I ISM HA as we call it. We believe this big 
new agency has a vital role to play in meet- 
ing the challenges of health care in the 
1970s. 

The aim ol HSMHA is to strengthen each 
component involved in the delivery of care. 
We are involved in partnerships with every 
element of the purveyor system — the physi- 
cians, the hospitals and other community 
institutions and agencies, state and regional 
authorities, voluntary groups. We are also 
in partnership with the consumers of health 
care who have an important role to play 
in assuring that they are well served. 

Within HSMHA, several specific pro- 
grams provide us with levers for helping to 
raise the capacity of the national health 
resource at the community level, where 
medical care happens. 

The National Center for Health Services 
Rese u (h and Development, formally estab- 
lished on July 1 of last year, stimulates 
and supports experimentation with new 
methods of delivering health care. It seeks 
to apply sc ientifu methodology in the social 
and behavioral sciences to problems of 
medical tare organization and delivery in 
the community setting. Among its highest 
priorities are devising new approaches to 
the delivery of medical care for the poor 
and testing methods which show promise 
of controlling and reducing health care 
costs. The Medex project in Seattle is one 
example of an innovative approach spon- 
sored by NCHSR 8c D. 

Project grants under the Partnership for 
Health are encouraging new ways of deliver- 
ing care. They support innovative efforts of 
a variety of health institutions and agencies. 
Many of these projects are also reaching 
into neighborhoods and districts where care 



has been least accessible in the past, with 
emphasis on primary ambulatory care. The 
West Oakland Center is one of a growing 
number of such projects. 

The Regional Medical Programs consti- 
tute a powerful resource upon which the 
community may draw for resolution ol 
health problems. They pull together into an 
eflc< live I uni tioning alliance the lull medi- 
cal strength of the region, to assure that the 
best in care can in fact be delivered where it 
is needed. 

The Maternal and Child Health pro- 
grams formerly administered by the Chil- 
dren's Bureau of HEW have just been 
transferred to HSMHA this past month. 
I hey represent M'Im million of Federal 
suppoit lor project and lot inula gi ants to 
States and communities. Much of this sup- 
port underwrites primary care in the family 
and neighborhood setting, including family 
planning services as an integral part of 
health care. The new organizational place- 
ment of these programs gives us an oppor- 
tunity to strengthen greatly the total impact 
of our efforts. 

At a somewhat more sophisticated level 
of care, we have a strong lever in the Com- 
munity Mental Health Centers Program. 
The intent here is to deliver mental health 
services as a part of the total health care 
package within a community. 

The Hill-Burton facilities construction 
program has long been a primary tool for 
enhancing the capacity of the total system. 
As priorities of need are changing, the 
emphasis of this effort is changing toward 
helping the hospital make its maximum 
contribution to the total spectrum of com- 
munity health care. 

As we view them, these and the other 
Federal health service programs should con- 
stitute resources on which the community, 
and its private medical institutions, can 
draw. The place where they need to fit to- 
gether is in the community. Our task as 
administrators is to help this synthesis to 
happen. 



HEAL! 11 ( \kl FOR I HE 1970's 



197 



Our support of areawide planning agen- 
( it's undei the Pai tncrship lot I [callh A. i is 
one mechanism designed to help achieve 
this synthesis at the community level. The 
role of these agencies that we see emerging 
is one ol community trusteeship. These 
agencies should bring together the con- 
sumer and the purveyor of health services 
to oversee the distribution and use of re- 
sources, identify the unmet needs and set 
realistic priorities. They represent not an 
operating agency but rather a focal point 
Eoi community responsibility in health. 

This batter) ol Federal health programs, 
plus others that could be listed both within 
and outside HSMHA, does not constitute a 
solution to the problem. Rather, it con- 
stitutes an invitation. If these programs are 
to work at all, they must be met halfway — 
and more than halfway — by the private in- 
stitutions ol health care. You, here in The 
College of Physicians of Philadelphia, and 
your colleagues and counterparts across the 
Nation, are the ones who ultimately must 
resolve the health care crisis. 

The crisis is very real. The people of this 



country knoM what good health care means, 
.ind the} want il very much. I he) a i e noi 
satisfied with what they are getting, with 
the price they are paying for it. You can 
hear the voices of discontent in the poorest 

ghetto .ind in the si sophisticated unk- 

tail party. 1 hese voices will not be quiet 
until the need the\ express is fulfilled. 

Looking li.nk across 200 years, I would 
sa\ that the Philadelphia College of Physi- 
cians is no stranger to crisis. It was born in 
crisis and its founders were involved in rev- 
olution. The purposes to which it was 
dedicated are alive and meaninglul toda\ 
to advanc e the science of medicine, to lessen 
human misery, to bring order and uni- 
formity to health care. 

All thai has changed is the context — of 
quani itative demand for medical excellence 
undreamed of two centuries ago. The Col- 
lege of Physicians of Philadelphia, on the 
threshold of the 1970's, faces the revolu- 
tionary challenge of helping to make that 
medical excellence universally available 
with equity, with efficiency, and with 
human dignity. 



125th Anniversary Salute: The Philadelphia 
Birthplace of the American Psychiatric 

Association 1 



By ROBERT ERWIN JONES, M.D. 2 



ON the evening of October 15, 1844, 
iliiiiccn 1 ihysicians assembled in the 
parloi (Figure \) of a red brick 
( .coi g i.in l.umliouse (Figure 2) on the 
gioiinds ol the Institute of the Pennsylvania 
Hospital, the home of the superintendent, 
l)i . I homas S. Kil kb] ide. 



This modest setting was the birthplace of 
the Inst national medical organization in 
America. The men were superintendents of 
thirteen ol the twenty mental hospitals 
which existed in the country at that time, 
and they called their group the Association 
ol Medical Superintendents of American 



— r- 






















1 SSJ 



Fig. 1. First meeting place of the founders 
1880 oil painting by Liberty Tadd shows the ( 
Kirkbride at Haverford Avenue and 4tth Stieci 



1 This paper appeared in part in Psychiatric 
News, official newspaper of the American Psychiatric 
Association, Vol. IV, No. 10, October 1969, pp. 12- 
13. 

2 Associate Medical Director. The Institute of the 
Pennsylvania Hospital, 111 North 49th Street, 
Philadelphia, Pennsylvania 19139. 



of the American Psychiatric Association. This 
lining room-study in the home of Dr. Thomas 
in Philadelphia. 

Institutions for the Insane, now known as 
the American Psychiatric Association. Its 
founding preceded the organization of the 
American Medical Association by three 
years. 

Built in 1796, the house was previously 



198 



21 ii i 



ROBERT I RWIN [ONES 



'9 



■jfi* /A* r / /■*»*{. ///v;vt^uy./..„, i .// J 

j.;..>:.. y,-, £* ''■•» 

(■ >// J, 7r& o ///U <4 > as i -•• m >/ju 

-At/tor, <■ *.<■.€/. A. 

/cui. V Juiln KtjktvJrArtL SkJa*i MiH^J CI. 

C' M ... /5< s A.,/,./u 

..'■}>!<,{:,.'„ Jt. €.Ml& <Gu—A \ vAy 4*»w 



,'.1 i, I,* . / 

j jfc- 



FlG. 4. Signatures of the 13 founders in the 
"Visitors Book" at Pennsylvania Hospital. Wives 
also attended the lirst convention. 



the residence ol Paul Busti, a successful 
Italian immigrant merchant and representa- 
tive ol a Dutch trading company. A promi- 
nent avenue in Buffalo, New York, still 
hears his name. 

This landmark in the histoiy ol Ameri- 
can medicine has been completely restored 
(Figure 3) and now serves as a recreation 
center lot a neighborhood playground. The 
original furniture and objets d'arl from the 
room are preserved in the historical museum 
at Pennsylvania Hospital. Many of the 
books have been donated to the APA li- 
brary in Washington, D.C. 

The hospital "Visitors Book" contains the 
onh known record (Figure 4) of all 13 signa- 
tures of the APA founders. Dr. Kirkbride's 
correspondence contains letters from all 
Eounders except Dr. Samuel White, the first 
vice-president and oldest of the group, who 
died a few months after its founding. 

The founders' letters to and from Dr. 
Kirkbride, first APA secretary and later 




Fig. 5. The Jones Hotel, scene of the officia 
beginning of the American Psychiatric Association, 
no longer stands on Chestnut Street above 6th, one 
block from Independence Hall. 



Fig. 6. Dr. Thomas S. Kirkbride, first secretary 
of the APA and host of the first convention. 



\MI Kit \\ I'sN ( I II A I RIC Assoc I \ I |( )\ 



H 1 1 



president, rceoid ih.it the ide;i lor the orga- 
nization developed in the spring of 1814 
w hen Dr. Samuel Woodward, siipei inlend- 
ent of the Stale Lunatic Asylum at Wor- 
cester, Massachusetts, journeyed south to 
\ isil Dr. Francis r. Stt ibling ol the West ei n 
Lunatic Asylum in Staunton, Virginia. Dr. 
Kirkbride wrote to Dr. Stribling (June I."). 
1844): 

" \s i espec ts a i onvciil ion ol I he Medic al 
Superintendents ol Insane Hospitals, I 
agree with von that much benefit might 
result from such a meeting, particularly as 
respects the statistics of such institutions. 
I here are some difficulties in the way, how- 
ever, and preparatory to a meeting it ap- 
pears to me that all should be aware of the 
matters likely to be discussed and have some 
idea of what plans are likely to be proposed 
for general adoption. To be efficient, the 
action of such a convention should as far as 
possible embrace all the asylums of char- 
acter in the country. Should Philadelphia 
be selected as the place for meeting, I should 
be very glad to do everything in my power 
to make all who attend perfectly at home 
and to see to any preparatory arrangements 
that may be required." 

On August 22 he wrote: 

"1 . . . shall take great pleasure in making 
arrangements you suggest, relative to the 
meeting of Physicians to Hospitals for the 
Insane to be held in Philadelphia in Octo- 
ber next. I had already concluded to make 
an arrangement with Mr. Jones for any ac- 
commodations we might desire, and no 
better place for first getting together could 
he designated." 

At Dr. Kirkbride's invitation, the super- 
intendents gathered for dinner at the Kirk- 
bride residence. There they formulated 
some preliminary plans, which were con- 
firmed the following day when the group 
met at ten o'clock in the morning at the 



[ones Hotel (Figure .">), whit h stood on 
Chesinui St i eel aho\e lit 1 1 . one hlo(k liom 

Independent e Hall. 

The founders quickly developed a high 
rcgaid lot one anolhei and an cspirit <\e 
corps among themselves in caring loi the 
"(lass ol unfortunates," as l)i. Stiihling 
called the insane. Isa.u Ray referred to the 
group as "In ei hi en"; [ohn S. Butler nick- 
named them the "Old Originals." They 
joked aboul themselves as "mad doctors" 
or "insane doctors." None, of course, called 
himsell a ps\c hiati ist. although Plim Faile 
came close bv calling them "rich psy- 
c hiatci s." 

On the evening of October 20, 1844, the 
Association adjourned to meet in May 1846, 
in Washington. D.C. The members felt 
that theii meeting had been a success. Dr. 
Samuel Woodward, who was elected the 
li i si i n esident, wrote to Dr. Kirkbride: 

" The time spent in Philadelphia was one 
of the most profitable and agreeable seasons 
that I have ever enjoyed. I trust much good 
will come from the convention and hope 
the ardour manifested at the meeting will 
not be suffered to cool so as to prevent full 
and able reports on all subjects assigned to 
committees." 

And years later, in 1854, Dr. Ray wrote 
to Dr. Kirkbride: 

"If our yearly conventions had accom- 
plished nothing more than to make us 
acquainted with one another, and with 
other institutions beside our own, creating 
Icelings ol personal i egai d and mutual sym 
pathy, I should think they had not been in 
vain." 

Dr. Kirkbride (1809-1883) (Figure 6) was 
a Fellow of The College of Physicians of 
Philadelphia. His portrait by Howard R. 
Butler hangs in Thomson Hall of the Col- 
lege. 



Memoir of Sir Henry Hallett Dale 
1875 1968* 

By GEORGE B. KOKI.I.K, I'll. I)., M.D. 



THE death (.1 Sh Henrj Hallet) Dale 
al the age <>l 93 on |ul\ 23, I9(i8, lias 
been n ul\ < hai a< tei 1 /< ■« 1 .is 1 he end 
<>l an era (I). Willi the exponential in- 
crease in the numbers of investigatoi s in 
all fields ol sc ieiu e dm i'iil; the piescnt cen- 
tury, only a very lew ol theii names can 
be expected to achieve a clegiee ol per- 
manency that will insure llieii being 
quoted beyond the Immediate Euture, ei- 
ther in histories of science or in the bib- 
liogiaphics of contemporary research and 
review publications. Sit Henr) Dale will 
smeh be one of these. His extensive series 
of brilliant and meticulous investiga- 
tions in several areas of pharmacology and 
physiology, along with his carefully drawn 
conceptional conclusions, established him 
as one ol the world's foremost figures in 
these disciplines. Dale's research achieve- 
ments were recognized In main awards 
and honors, including the Nobel Prize 
which he received along with Otto Loewi 
in 1936 for their major, independent con- 
tributions towards establishing the theory 
of neurohumoui.il transmission. Dale 
served, and consequently influenced in a 
still broader sense, medicine and science in 
general in his successive capacities of 
President of the Royal Society, of the Brit- 
ish Association, of the Royal Society of 
Medicine, and of the British Council, as 
well as that of Chairman of the Scientific 
Advisory Committee to the British War 
Cabinet during World War II. As Chair- 
man of a Conference of the Health Organi- 
zation of the League of Nations in 1925, 
he was primarily responsible for the adop- 

* Prepared at Pahlavi University, Shiraz, Iran, 
at the request of the Council of The College of 
Physicians of Philadelphia. 



tion ol international standards of drugs 
that required biological standardization. 
In addition to his activities in these 
official posts, Sir Henry was throughout 
his life regarded by the medical community 
as a source without peei for sound judge- 
ment, careful criticism, and enthusiastic 
interest, both at scientific meetings and 
in the private interviews for which he 
made himself available freely until the 
time of his final illness. 

It would be impossible in a short space 
to review Dale's direct scientific contribu- 
tions, their broad significance, and their 
major impact on subsequent research. This 
has been done admirably in a memoir 
prepared by his longtime friend and scien- 
tific collaborator, William Feldberg (1), 
and in a delightful anecdotal account writ- 
ten by Dale himself, half-a-dozen years 
before his death (2). Accordingly, only the 
most important highlights of his scientific 
career will be mentioned here. 

Following his graduation from Cam- 
bridge in 1898, Henry Dale remained two 
additional years as a research student in 
physiology under J. N. Langley. He then 
completed his clinical studies for his med- 
ical degree at St. Bartholomew's Hospital, 
London; remarkably for a pharmacologist 
of that time, this was his last formal aca- 
demic affiliation. Having decided upon a 
career in research, Dale spent a brief period 
in Paul Ehrlich's Institute at Frankfurt. 
He then accepted an appointment to un- 
dertake pharmacological investigations at 
the then recently established Physiological 
Research Laboratories of Burroughs Well- 
come and Company, where he remained as 
an active investigator for ten years, and 
subsequently served as Chairman of the 



202 



Ml MOIR 01 Ml< III MO ll \l I I I I DALE 



203 



Wellcome rrust, I Ik- remainder ol Dale's 
careei .is a direcl participanl in research 
was spenl al the National Insiituu- for 
Medical Research, when- Ik- was Director 
Erom 1928 until lus retirement in 1942. 

As I). ik- himsell often pointed out, sev- 
eral o! his major discoveries originated 
Erom an investigation ol the pharmacolog- 
ical pro] ici l ics ol the crude di ug, cigol, 
which he undertook at the suggestion of 
Sii I Itm \ Wellcome after joining the 
company's laboratoiv. These included the 
lusi dcinonsl i at iou ol adicnergii blockade; 
the isolation, phai mac ological characteii- 
zation, and exj>loi at ion ol the physiolog- 
ical oi pathologic nl significance' of tyra- 
inine, histamine, and acetylcholine; and 
the discovery of the oxytocic action of pos- 
terior pituitary extract. From related stud- 
ies. Dale introduced the concept of lixed, 
as opposed to calculating, antibodies as 
the basis ol anaphylaxis and hypersensi- 
tivity. 

Dale's major research achievements were 
in the conception, establishment, and ex- 
tension of the theory of the chemical trans- 
mission of nerve impulses, or neurohu- 
moural transmission. Earl\ suggestions of 
i his were made by Du Bois-Rcymond and 
Lewandowsk) in the preceding ccniui\. 
and l>\ T. R. Elliott and J. N. Langley 
shortly before Dale's pi cceptecship in the 
latter's laboratory. While comparing t he- 
actions of a large number of synthetic 
epinephrine like compounds in collabora- 
tion with G. Barger at the Wellcome lab- 
oratory, Dale like his predecessors was im- 
pressed with the resemblance between the 
actions of main of these drugs and those 
of the sympathetic nervous system; how- 
ever, with characteristic caution he 
pointed out that epinephrine did not 
mimic such nervous influences as closely 
as did norepinephrine, a compound which 
then was not known to occur in the body. 
(Oyer thhty years later, von Eider showed 
that the actual sympathetic transmitter is 
in fact norepinephrine). Shortly after- 



w.uds, during his analysis ol the actions 
ol acetylcholine, Dale noted the close iden- 
tity betwee n iis ac tions and i hose of 
parasympathetic impulses. During these 
studies. Dale coined the teiins "sympatho- 
mimetic" and "parasympathomimetic," 
which like main otheis which he- intro- 
duced are standaid in the current medical 
literature. Endowing Olio Eoewi's dem- 
onstration that vagal impulses to the frog's 
he.n l are transmitted by a chemical agent, 
and his identification of the transmitter as 
acetylcholine shortly afterward, the sub- 
sequent confirmation and extension of this 
principle were due largely to the work of 
Dale and his many col tabulators. Out- 
standing among ihis gioup were (.. E. 
Brown. J. EI. Burn, J. Gaddum, W. Kc-ld- 
berg, and M. Vogt. Togcthei. ihe\ showed 
that acetylcholine is ihe iiansnhttei also 
lor mammalian postganglionic parasym- 
pathetic fibres and a few sympathetic fibres, 
preganglionic fibres of the entire auto- 
nomic nervous system, and the motor 
nerves of skeletal musc le; in addition, ihe\ 
obtained suggestive evidence of choliner- 
gic transmission at certain sites in the cen- 
tral nervous system, which has been amply 
confirmed in recent years. 

The sequential announcement of these 
findings during the 1930's must have gen- 
erated considerable excitement, for unlike 
now, the concept of neurohumoural trans- 
mission was at that time by no means 
generally accepted. Fur example, w hen Dale 
presented at one meeting the evidence that 
acetylcholine is the transmitter of sym- 
pathetic impulses tu the sweat glands, the 
physiological significance of his findings 
was challenged b\ one young listemi 
(who subsequently also received a Nobel 
Prize). Dale replied that the same mis- 
givings had occurred to him, but that he 
had reassured himself as follows: A few 
days previously, he had played several sets 
of tennis, then adjourned immediately 
to the laboratoiv, where he had extracted 
his socks with saline solution and tested 



2D1 



GEORGE B. KOELLE 



the extract for acetylcholine-like activity on 
the leech-muscle preparation; the result 
had been distinctly positive. 

A total list of Sir Henry Dale's collab- 
orators during his active investigative years 
would include many of the world's out- 
standing pharmacologists and physiologists 
of two generations. Among these were 
two of Philadelphia's most distinguished 
medical scientists, Alfred Newton Rich- 
ards and Julius H. Comroe, Jr. It was a 
historic occasion in September, 1953, when 
Dale, Loewi, most of the aforementioned 
investigators, and a host of others met in 
Philadelphia for a two-day Symposium on 
Neurohumoural Transmission (3). This 
was probably the last formal assembly of 
these two giants of research, their disciples, 
and their scientific proponents and ad- 
versaries. The years that have followed 
have seen tremendous advances in our 



knowledge of the function of the nervous 
system at all levels, from the behavioral 
to the molecul.n. Jn pace with this prog- 
ress has been the development of a large 
number of new and more effective drugs 
for the treatment of nervous and mental 
disorders, the neurogenic aspects of hyper- 
tension, and a variety of other illnesses. 
The foundation of much of this work 
can be traced back directly to the researches 
of Dale and his associates. The College of 
Physicians of Philadephia is indeed hon- 
ored to have had Sir Henry Hallett Dale 
among its Honorary Fellows. 

REFERENCES 

1. Feldkerc, W.: Henry Hallett Dale, 1875-1968. 

Brit. J. Pharmacol. 35: 1-9, 1969. 

2. Dale, H. H.: Pharmacology during the Past Sixty 

Years. Ann. Rev. Pharmacol. 3: 1-8, 1963. 

3. Koelle, G. B. and Krayer, O., Ed.: Symposium 

on Neurohumoural Transmission. Pharmacol. 
Rev. 6: 1-131, 1954. 



The Custodianship Cabinet of The College 

of Physicians 

The recent redecoration of the Hutchinson Room, of] the main foyer of the 
College Hall — instigated by President Francis C. Wood, supervised by Mrs. 
Wood, and generously contributed as a gift of Dr. and Mrs. Wood to The 
College of Physicians — required the moving of the Custodianship Cabinet, 
which contains mementos of five of the world's greatest healers. A pamphlet, 
describing the mementos, was found beneath the glass case. 

The author of the pamphlet could not be identified. However, a search by 
W. B. McDaniel, 2d, Curator of Library Historical Collections, revealed that 
the booklet is referred to in an account of a "Special Meeting in Honor of 
Madame Curie" at the College on May 23, 1921. The opening overture is an 
"Address of Robert Abbe, M.D., New York." Mrs. L. M. Holloway, Associate 
Curator and Cataloguer of Historical Materials, then discovered that there is a 
copy of the pamphlet among Dr. Abbe's collected reprints, a fact which indi- 
cates that he is the probable author. Miss Marie deBenncville provided bio- 
graphical information about Dr. Abbe. 

Because the pamphlet has been out of circulation for many years and because 
of its rarity, it is reprinted in this issue in a form similar to the original. The 
address of Dr. Abbe (Figure 1), collector of the mementos, is also reprinted as a 
preamble to the pamphlet itself. 

The Custodianship Cabinet had its beginning in 1920 when Dr. Abbe pre- 
sented the College with the gold watch of Benjamin Rush. The next year he 
donated $5000 with ivhich to maintain or increase the cabinet of mementos of 
historic persons who greatly added to the advancement of science. 

Dr. Abbe was born in New York City in 1851. In 1922, he became interested 
in the many stones that he found on a street in Bar Harbor, Maine. This interest 
resulted in the founding of the Lafayette National Park Museum of the Stone 
Age Period in Mt. Desert Island, dedicated in 1928. 

His chosen profession, however, was medicine, and his practice was based 
upon the soundest principles. One biographer wrote: "His alert mind and 
pioneer spirit led him far beyond the routine of a surgeon's practice." He 
worked with the hope that much that he was doing in surgery might be better 
and painlessly done through future discoveries. He became a missionary for 
the discovery of radium by Professor and Madame Curie, but he met with criti- 
cism for his prompt use of the element. 

Additional mementos have been added to the cabinet since 1921, and a 
pamphlet describing them will be prepared. 

The conditions of the custodianship require that, if a custodian fails to name 
his successor, one shall by chosen by the Council of The College of Physicians. 
The most recent custodian (1928-39), Dr. William J. Mayo, died without nam- 
ing a successor. The task of choosing a new custodian, after a 30-year lapse, now 
aiuaits Council. 

The Editor 



205 



206 



ROBERT ABBE 



SPECIAL MEETING IN HONOR OF MADAME CURIE* 
ADDRESS OF ROBERT ABBF, M.D. 
New York 



You will find ;m illust i alcd booklet in 
each seat of this hall describing the memen- 
tos of the five great names of om profession 
and of science, which are the milestones of 
scientific progress in the healing art dining 
the past century or more. These mementos 
are tonight exhibited for the first time in a 
(.isc in which thev will permanently remain 
in you] keeping. 




Fig. I. Robert Abbe, M.D., originator of the Cus- 
todianship Cabinet. 

Your reading of this booklet now or at 
your leisure will save the time necessary for 
the telling and enable me to occupy the few 
moments before Mme. Curie's coming to- 
night to explain more fully the object of 
her presence here and of her visit to our 
country. 

Those of us who arranged her itinerary 
in this short six weeks between her leaving 

* Read May 23, 1921. 



Paris and returning to it have faced an 
enormous demand for her presence at uni- 
versities, societies and cities all over our 
country. Knowing her delicate health, and 
the need of conserving her strength, we have 
chosen such visits and duties as would satisfy 
her wishes and the universal desire of in- 
siii in ions of learning to see her, and yield 
the greatest benefit to science and popular 
education without fatiguing her, and yet 
stimulate her life, if possible, to complete 
i he u oik lei I ul work ahead ol her. 

She comes to us after many years of 
fatiguing labor. The great war took toll of 
the University of Paris from the first gun 
fire. Most of the students and the great 
corps of professors and teachers abandoned 
the class-room for the battlefield. She was 
among the first to abandon her laboratory, 
and until the day of the Armistice was at 
iIk hont witli her daughter in X-ray work. 

When she returned, all was desolate. It 
was as if life were either to stop or to begin 
over again. 

By almost an act of genius the initiative 
of an American, Mrs. William B. Meloney, 
accidentally a visitor to Paris on another 
mission, touched a key that evoked an ap- 
pealing note of sympathy in the hearts of 
the women of our country. An extraordi- 
narily spontaneous response called out 
working committees of women all over our 
land. By admirable organization one of the 
largest purely woman's movements has 
excited a sympathetic feeling for the tri- 
umph of pure science — as illustrated in 
Mme. Curie — and also by innumerable 
small contributions from women created a 
fund to present her with the accessories for 
equipping her disorganized laboratory. 

She has confided the fact that one of her 
desires has been to come here tonight and 
personally present and dedicate the historic 
scientific instrument which you see before 



SPECIAl MEETING IN HONOR Ol \l \ l > \ \l I CURIl 



207 



you to such educative purpose as its pres- 
ence may evoke. 

When I liualh brought ii vilely to my 
office .1 few days ago — after many vicissi- 
tudes ami unpac ked it tenderly, my assist- 
ant was touched by its impressive meaning 
and said. "Don't you think it will be lonch 
over here?" 

I said. "Yes, perhaps, until Mine. Curie 
COines and places bet hand affectionately 
on it and commends it to our care." 

That, my friends, she will do in a lew 
moments. 

Her reception in this country will be a 
just tribute to one ol the world's most dis- 
tinguished woman scientists; but nothing, 
I judge, can ecpial the- momentous and 
thrilling ovation given to her a Eortnight 
ago in Paris on the eve of her departure. 

The scene was the great Opera House. 

The stage was set by Guitry, the Belasco 
ol the French Theater. The house was 
packed with a distinguished audience. 

Flags, decorations and music were elabo- 
rate. The curtain rose on a stage filled with 
officers of state, professors of the univer- 
sity — in robes — and in the center the 
modest, shrinking, woman savant. Splendid 
addresses were given, laudatory and impres- 
sively true. 

Then the curtain fell, only to rise again on 
a stage cleared of everything but a small 
table behind which Sara Bernhardt, the 
greatest living tragedienne, rose to deliver 
a brilliant eulogy written by the master of 
French dramatic writing, Rostand. The ef- 
fect was thrilling, but thunders of applause 
and calls for Mute. Curie failed to bring her 
from behind the scenes where she had been 
bashfully listening to Mme. Bernhardt. I 
have been told by a lady who witnessed the 
scene that there was no climax, but a succes- 
sion of tributes, one after the other, fol- 
lowed by an elaborate "movie" of Mme. 
Curie's life espe< iall) prepared by actors on 
the scene of her early home and laboratory 
work with her lather, professor in the Uni- 
versity of Warsaw, where she was his de- 



voted assistant until she came to Paris at 
twenty years of age. 

The scenes (hen depicted French univei 
sit) work in laboratory and mine, with de- 
tailed views ol the \ ei ilable w oi kshop and 
scenes of her triumph in the epoch-making 
discovery of radium. 

From such an emotional farewell she 
made het lust crossing ol the ocean, and, 
yesterday, was the centet ol interest at the 
most momentous sc ientilu event e\ei given 
at the White House, when President Hard- 
ing presented to hei the gilt from the 
women ol our countiy, a gram of radium. 
The President made one of the most beauti- 
ful addresses I have ever heard, full of 
charm and dignity. Mine. Curie responded 
most happily. Before her was the fine 
mahogany box containing the precious 
mineral which she had discovered, confined 
in an interior case of lead weighing a hun- 
ched pounds. The little gold key to this box 
was presented to her by the President, 
which she afterward wore around her neck 
on a tri-color ribbon. 

From the fatigue of that and other cere- 
monies she comes to us tonight with par- 
ticular pleasure to dedicate the memento 
which will repose in your cabinet. You will 
see in her a woman of rare charm, but t he- 
antithesis of all that savors of pompous- 
ness. She has the tenderest heart in her frail 
body, but the keenest sense for all scientific 
conversation, with unalfected disdain ol 
small talk. 

I desire to say a few words regarding the 
care of mementos you see on the platform 
and the custodianship ol them, worthy, I 
hope, ol your perpetuation. 

More than ten years ago, as you know, 
there was presented to me the beautiful 
gold watch of Dr. Benjamin Rush, one of 
your society's founders and a hero of Rev- 
oluntionarx days. It was made the subject 
of a custodianship to be held as an honor, 
by successive members of our profession 
who represented the same high qualities of 
mind and lifework as he did. The first 



20H 



ROBERT ABBE 



c 1 1 si o< 1 i a 1 1 was I)i. Weir M i I c lull. He those 
Dr. Simon Flexner as his ideal and successor. 
Di Flexner, afte] three years, passed it on 
to Dr. William H. Welch, who accepted the 
honor and is its present custodian, to the 
delight of everyone, saying: "Why! It's like 
the gold-headed cane." 

I saw the gold-headed cane in the College 
of Physicians' cabinet in London last sum- 
mer, and with ii were five other treasures: 
First, a pair of scissors belonging to Jcnner 
and a cow's horn from one of the historic 
animals used in vaccination; second, a small 
wooden stethoscope used by Laennec; third, 
a short ebony pointer used by Harvey in his 
lectures on the blood; fourth, a small silver 
platter given in 1661 by the Fellows of the 
College, but stolen in 1666 at the looting 
during the great fire of London. It was lost 
for 250 years and was recovered at a collec- 
tor's sale of old silver a few years ago. 

1 u as inspired l>\ I Ins sin. ill l;) oup and l>\ 
lis elle< i upon me lo think I might attpihe 
some things worthy to add to our custodian- 
ship. My hope was of Lister, Pasteur and 
Curie, but from the first inquiry I was given 
d i si i mi agement. 

Pushing my endeavors during my short 
stay in London and Paris, I was at last re- 
warded by three remarkable gifts and veri- 
table treasures, of each great name, and 
these I present tonight: 

A box of surgical instruments used by 
Lord Lister. 

A large model of a tartrate crystal used by 
Pasteur. 

A wonderful historic instrument made by 
Pierre Curie, and used by him and Mme. 
Curie in her immortal discovery of radium. 

These memorable souvenirs probably 
cannot be duplicated anywhere outside of 
the Lister, Pasteur and Curie Museums. 
They were secured through the assistance 
of Dr. Keen and Dr. Gibson, and by the 
gifts of Sir Rickman J. Godlee (Mr. Lister's 
nephew), of Calmette and Roux (Pasteur's 
assistants and successors), and of Mme. 
Curie herself. 



In the possession of this institution there 
has been an inkstand of Jenner, which was 
given by Dr. Weir Mitchell, and has been 
permitted to repose in this cabinet as one 
of the memorable souvenirs. 

With these five in the cabinet are por- 
traits of each distinguished scientist and a 
beautifully bound volume of historic data, 
biographic notes and autograph letters of 
each. 

In addition there are the cutodianship 
conditions and portraits of each successive 
< ustodian, with his lettei ol nomination 
and acceptance. 

T hese, in the coming years, will con- 
si itute a memorable collection of our own 
illustrious scientific, educational and hu- 
manitarian fellow-men whose deeds and 
lives will be worth emulation. 

When, in a few minutes, Mme. Curie 
arrives and President Taylor invites her 
to formally present her great gift, to place 
her hand upon it, affectionately bid it good- 
bye and commend it to its good purpose as 
a permanent part of this cabinet, we will 
realize that for all time it will bear the 
actual finger-prints of the discoverer of 
rati i tun, as the Pasteur crystal model, the 
Lister instruments, the Jenner inkstand and 
the Rush watch do of their former owners. 

If I were asked again, "Will it not feel 
homesick"'" I would say: "Let us imagine 
some future evening here in this beautiful 
hall after the scientific audience has gone, 
the lights are turned out, the janitor has 
made his rounds, locked the door and gone 
home, the moonlight streaming in the tall 
windows near the case, and the Liberty Bell 
in Independence Hall has struck midnight 
by some fairy hand. Then the little fairy 
spirits that stand guard over these memen- 
tos awake. From the Curie instrument one 
stretches out his hand and touches another 
of one guarding the Pasteur crystal, grasps 
it and a chatter in French breaks the silence. 
This wakes up the sprightly guardian of 
Lister's instruments and Jenner's inkstand, 
who join in an international parley at 



SPECIAL MEETING IN HONOR OF M UDAME CURIE 



which i tic American spirit of Dr. Rush 
(liinl)s out of his invisible retreat and they 
all (lain e about and nan ate theii u < mdci I ul 
past. 

" I hen one can see as the dawn breaks 
ihe\ all hide again invisible. I he janitor 
unlocks the library and vistors come to 
study and pay homage to the great names 
we all worship. 

" I his historic instrument will not be 
lonely." 

()l all the galaxy of stars illuminating the 
past, none commands greater reverence than 
Pasteur. 1 he portrait of him most treasured 
h\ the Institute has been perpetuated in a 
fine large etching presented to us by Cal- 
mettc and brought over by Dr. Keen. It is 
in beautiful contrast as showing the fine 
si u nit \ of his later life to the earliest 
known portrait of which 1 find a copy in 
Dr. Weil Mitchell's collection in youi li- 
brary. This early one is so rare that few 
know of it. That early face is the pure 
scientist, typified in a quotation which is 
a tribute to his character, taken from one of 
his letters to his young love in offering his 
life to her. He says: 

"Time will show you that below my cold, 
shy and unpleasing exterior there is a heart 
full of affection for you." 

Perhaps the main influence of this memo- 
rial case will be a tendency to raise the tone 
pi the life of our future professional men 
by spreading before us some of the attri- 



butes of the highest lives devoted to the 
healing art, whose hearts have been com- 
pletely devoted to this fruitful work. 

There exists today, as always, a com- 
mercial tendency which needs to be neu- 
tralized. It is the same in business. One 
reads on the advertisement boards of a busi- 
ness college this legend, "We turn time and 
brains into money." What sacrilege! Time, 
given in our short lives for some worthier 
purpose "lime is Mine, 1 will iepa\," 
s.i it h the Lord. And brains, to search out 
the Creator, if happily we may find Him. 

Is there no greater aim than making 
money? Let those who have so given their 
lives turn their accumulated wealth into 
the treasures of our laboratories and uni- 
versities, and, after all, find the joy of serv- 
ice. Already fortunes are being diverted to 
science. 

It has been a heai twai ming sighl to see 
the universal response of the women of our 
broad land, poor and rich, contributing as 
they could to the fund to equip Mme. 
Curie's laboratory. The great good that has 
emanated from them is sure to be now con- 
tinued. 

# # # 

At the close of Dr. Abbe's address, 
Madame Curie arose and placing her hand 
on the apparatus said, "I am glad to present 
this instrument to so distinguished a 
society." 



THE CUSTODIANSHIP OF 

RUSH TENNER' PASTEUR 
LISTER' CURIE 
MEMENTOS 

IN THE CABINET OF 
THE COLLEGE OF PHYSICIANS 
OF PHILADELPHIA 




HELD IN SUCCESSION BY 
REPRESENTATIVE MEMBERS OF THE 
MEDICAL PROFESSION OF THE 
UNITED STATES 



THE CUSTODIANSHIP CABINET OF 
THE COLLEGE OF PHYSICIANS 



THE COLLEGE OF PHYSICIANS 

PHILADELPHIA 



THE CUSTODIANSHIP CABINET 



OF THE COLLEGE OF PHYSICIANS 



THE College of Physicians of Philadelphia has represented 
the lofty purpose and spirit of scientific medicine since 
the early days of our country, and seems the fitting repository 
of historic souvenirs, the nominal custodianship of which is 
an honor — worthy of our best men. 

The spirit which actuates the lives of men of great accom- 
plishments, is epitomized in these five representative scientists 
and physicians to whom this is dedicated. 

The compelling force in all may be said to be: intensive 
preparation; unlimited resourcefulness in wor\; close and 
exact observation; strong conviction of right; defiant bravery; 
idealism; culture; religious faith; humanitarianism; and edw 
cative zeal. 

Rush said, " I ma\e everyone whom I meet contribute to my 
improvement." 

Jenner wrote, "I am not surprised that men are not than\- 
ful to me, but I wonder that they are not more grateful to God, 
for the good which He has made me the instrument of con* 
veying to my fellow creatures." 

Pasteur said, "Opportunity comes to him who is prepared." 

Lister said, "The scientist's public life lies in the wor\ that 
is his." 

Mme. Curie says, "I desire only to teach." 
In the belief that such exalted lives are found in every de- 
cade, often in humblest surroundings, it is probable that the 



man at the top will be more able to discriminate among corn- 
temporary wor\ers, and to choose one whom he considers the 
exemplar of such traits. 

The first chosen custodian of these mementos, Dr. Weir 
Mitchell, conceded by all to be such a representative spirit, 
was as\ed to name a successor, embodying the highest type of 
physician and educator, in productive scientific wor\. He 
chose Dr. Simon Flexner, of the Rockefeller Institute, ~Hew 
Tor\. He followed the provision that the incumbent custodian 
should choose his successor from the ran\s outside his own city. 
Dr. Flexner, after three years, as\ed to be permitted to pass on 
the honor during his lifetime, and chose Dr. Wm. H. Welch, 
of Baltimore, whom he considered the most worthy representa- 
tive in our time. Dr. Welch has accepted the honor, saying, 
"'Why, it's li\e the 'Gold-headed Cane,' " and has promised 
to choose a successor. 

At longer or shorter intervals, the choice must fall on men, 
not necessarily \nown by popular acclaim or professional s\ill, 
but always by great humanitarian accomplishments and un' 
tiring wor\. 

The letters of acceptance with portraits of each custodian 
preserved in the boo\s in this cabinet will ma\e, in time, an 
unmatched collection of distinguished autographs of notable 
American physicians. 

A sufficient fund has been given with this case of mementos, 
to perpetuate and enhance the collection. Thus it will always 
be an honor to be chosen custodian, either by the incumbent, 
or in default of such choice, by the Council of the College of 
Physicians. 



THE CASE AND MEMENTOS 

lHli.ii.iJ 




WITH BOOKS CONTAINING PORTRAITS, ILLUSTRATIONS, 
AUTOGRAPH LETTERS AND BIOGRAPHIC NOTES, WITH 
THE CONDITIONS OF THE CUSTODIANSHIP 

I A- 

First Custodian — Dr. Weir Mitchell, Philadelphia, 1910-17. 
Second Custodian — Dr. Simon Flexner, New York, 1917-20. 
Third Custodian — Dr. William Henry Welch, Baltimore, 1920-24. 
Fourth Custodian— Dr. W. W. Keen, Philadelphia, 1924-28. 
Eifth Custodian — Dr. Wm. J. Mayo, Rochester, Minnesota, 
1928-39. 



THIS CUSTODIANSHIP WAS FOUNDED BY ROBERT ABBE 
OF NEW YORK CITY, ASSOCIATE FELLOW OF THE 
COLLEGE OF PHYSICIANS, PHILADELPHIA 



DEDICATION 



■. I HERE is an ethical foundation stone in the 
education of a medical man, which is just 
as essential as book knowledge, and lab' 
|Wfj& oratory work. The subtle power of the 
* , ro names which rank high in our profession, 
makes an impression upon the student's early manhood 
and unfolding character. A virile force pervades him when 
he has the high example of character held before him. 

There are some names in our profession, which reprc 
sent our medical ancestors, as it were, whose very spirit 
evokes a thrill when we come into actual touch with their 
belongings, such as no ordinary thing inspires. The actual 
objects that felt the living touch of the great Pasteur, 
Jenner, Lister, Rush, Curie, and others of like fame, are 
more sacred to us, than the cloak of Charlemagne or the 
cocked hat of Napoleon, for example. It needs not more 
than one verified article which was the intimate personal 
property of such human beings to visualize for us the 
whole character of the owner, and thrill the observer. Who 
would not glow with interest and sympathy when he sees 
the instruments used by Lord Lister in the early days of 
his work and triumph? Who would not travel a thousand 
miles to see and hear the immortal Pasteur, who put into 
action those compelling thoughts evolved out of his giant 
brain? Recently, in this decade, a new light has radiated 
on science from the Curie laboratory in Paris, which has not 
only revolutionized the conception and calculation of the 
forces of nature, but has put into the hands of our profes' 
sion a weapon, hitherto unsuspected, to help control disease. 




BENJAMIN RUSH 
[1745-1813] 



BENJAMIN RUSH 



THE first of the five thrilling mementos in our cabinet 
is the beautiful watch of Dr. Benjamin Rush. Though 
there were doctors scarcely less cultivated and devoted, who 
dignified the early records of American medical service, yet, by 
common consent, theachievementsof Dr. Rush are preeminent. 




SHOE BUCKLE WORN BY DR. RUSH [ACTUAL SIZE] 



In his day the seal of great deeds was stamped on our 
country's history by Washington, Adams, Hamilton, Frank- 
lin, Lafayette and a score of other noted patriots. Dr. Rush 
was the intimate friend of these, and of all the savants of 
his day. His name has come down to our time as, per- 
haps, the most representative medical man who combined 



culture with patriotism, scientific zeal with literary at- 
tainments, and religious devotion, and an indomitable 
courage with unwearied power for work. 
This watch is inscribed: 

BENJAMIN RUSH 
SIGNER OF THE DECLARATION OF INDEPENDENCE 
OBIIT 1813 
RICHARD RUSH 
OB. 1859 
BENJAMIN RUSH 

It must have been his most highly prized personal posses- 
sion and his constant companion. Even at this day, after a 




THE WATCH OF BENJAMIN RUSH 

century and a half, it is a perfect time-keeper. It was his guide 
in all appointments, punctually kept, and must have been 



under the eyes of many great men of the day; perhaps it 
witnessed the last hours of national heroes. 

One feels a thrill when holding it in one's hand, and, as it 
ticks the seconds, one is drawn back in fancy, to the days 
when the same sound was heard by ears now deaf. It inspires 
in the visitor today, emulation of the spirit of its owner. 

Another heirloom, a silver shoe buckle, set with brilliants, 
worn by Dr. Rush, has been given to this cabinet by his 
great grand-daughter, Catharine Rush Porter (Mrs. J. Biddle 
Porter). It suggests the gallant and chivalrous coterie of 
gentlemen who surrounded the first president of our 
country. 




EDWARD JENNER 
[1749-1823] 



EDWARD J EN N MR 



THE second memento in our cabinet is an inkstand, one 
of the personal possessions of Edward Jenner. His 
name is honored by the English-speaking peoples not more 
than by the civilized world. 

This inkstand came into the possession of our loved Weir 
Mitchell, who used it reverently for years, and presented it to 
the College of Physicians at his death. 

It has a peculiar charm, because it stands for literary effort, 
besides signalizing the long, weary fight Jenner made by his 




THE JENNER INKSTAND 



writing and speeches, to obtain recognition for the principle 
of cowpox vaccination against smallpox. 

We realize the power for good of one indomitable will in a 
life-long fight to overcome prejudice and obstinate antago- 
nism of friend and foe. We think of the enormous uplift of 



civilized communities, from India and Russia through 
Europe to America, when freed from the dread scourge of 
smallpox. 

The lesson of Jenner's life may be epitomized as a serious, 
thoughtful, conscientious, studious development of one 
fundamental discovery, a fact that was the kernel of a newly 
revealed principle in medical practice — vaccine therapy. To 
him it was revealed truth, and, as such, having the conviction, 
he gave up the best of his life to defending and spreading it 
broadcast. On every side he met opposition, which he broke 
down with indomitable determination. 



THIS LOCK OF JENNER's HAIR, PRESENTED TO 
THE COLLEGE OF PHYSICIANS BY WILLIAM OSLER, 
MARCH 1, 1893, BEARS THE FOLLOWING INSCRIP- 
TION ON THE BACK OF THE LOCKET. "THIS HAIR 
WAS CUT OFF AFTER EDWARD JENNER's DEATH 
BY MRS. AUSTIN OF SLONE, HIS NIECE, AND 
HANDED BY HER TO ME. W. R. AWDRY, JULY 29, 
1892." BERKELEY, GLOUCESTERSHIRE, (ENGLAND). 




JOSEPH LISTER 
[i827'i9i2] 



JOSEPH LISTER 



OF Lord Lister we are the fortunate possessors of two 
valued souvenirs. The first is a small case of surgical 
instruments used by Lord Lister. It was a part of his equip- 
ment, both in Glasgow and in Edinburgh, while he was 
developing his principles of antiseptic surgery, and, in 
London, where he was invited to take the chair of surgerj 
in Kings College, but where he found the greatest difficulty 
in advancing his work. 

It is almost impossible to find any article personal to him 
outside of the Lister Museum, but, through the kindness of 




A SMALL CASE OF INSTRUMENTS USED BY JOSEPH LISTER 

[name PLATE INSCRIBED "j. lister"] 



Sir Rickman Godlee, a nephew of Lord Lister, and his 
biographer, we have been able to secure these two veritable 
articles. The box of surgical instruments has Joseph Lister's 
name on the cover of the case. They must have been used by 
him for many years. The instruments are of the make of 




lister's original tubes for tests of lactic acid fermentation 

"Young" and "Borthwick, Edinburgh," and "Weiss, 
London." 

Many of us have had the gratifying memory of seeing 
Lister operate, and will be impressed by the conscious sensa- 
tion, that, perhaps, these very instruments were seen by us 
in his hands. How near it brings us to the man, who, by 
patient labor, developed the Listerian principles! 

The second souvenir, full of human interest is a group of 
six small glass tubes, each with a thimble shaped glass cover, 
fitted in a rack made of four pieces of cut off glass tubing, 



wired together by silver wire, which is further twisted, rope 
fashion, about the tubes to hold them together upright. 

This rack is placed on a five inch square plate glass, and 
covered by a bell glass. 

In his earliest private researches he fashioned these with 
his own hands, to accommodate it to a "hot-box" for ster- 
ilizing at 300 , before introducing into the six tubes fresh 
milk, either sterile, or slightly contaminated, to demonstrate 
that if dust can be prevented from getting access to the 
putrescible fluid, infection is impossible. 

He used these tubes in his lectures, and for his own satisfac- 
tion, to show that milk could be kept sweet till it dried up. 
All these tubes contain the very remnants of his experimental 
fluids, some with and some without mould. 

These identical tubes are illustrated in his biography 
(Godlee, p. 267), and in his "Collected writings" p. 302. 



LOUIS PASTEUR 
[1822-1895] 



LOUIS PASTEUR 



HE fourth souvenir is of the great Pasteur. By singular 



good fortune we have something characteristic. 
Precious to the hearts of the French people is everything 
connected with the life of Pasteur. This souvenir was 
generously given to the College of Physicians of Philadelphia, 
by Calmette, of the Pasteur Institute, formerly assistant to 
Pasteur, and transmitted by the hand of Dr. W. W. Keen. 

It would be diflicult to acquire anything more precious than 
this model of a crystal, which Pasteur made, labelled, and 
mounted with his own hands, to use before his sceptical audi- 
ences in demonstrating the nature of crystals from wine fer- 
mentation. The chemistry of this had been a stumbling block 
to scientists. No explanation of why one of two tartrate 
crystals, showing identical analysis, turned polarized light to 
the right, while the other turned it to the left. 

Pasteur demonstrated his views with this model, in strenu- 
ous debate with his adversaries in 1862. This research and 
demonstration won him added renown as a chemist, and was 
the key to his future work. He unravelled the mystery of the 
cause of putrefaction and fermentation, and, in his own 
words, speaking to the Emperor, he said, "all my ambition is 
to arrive at the knowledge of the causes of putrid and con- 
tagious diseases" (1863). 

Two years later, Lister first read Pasteur's writings proving 
that putrefaction was of germ origin, and made his first 
demonstration of the efficiency of carbolic acid in surgery 
(March, 1865). He gives all credit to Pasteur for his great 




discovery. The world is indebted to Lister, however, for his 
undaunted bravery, his pioneer advocacy and application of 
this principle to surgery in the face of universal opposition. 

In that year Pasteur began an intensive study of the cause 
of the decadent vintages of France. The outcome of this was 

a proof that deterioration of wine with 
deposition of tartrates, was due to a 
low-grade bacterial fermentation, 
which could be arrested permanently 
by heating wines sufficiently to kill 
bacteria, but not hot enough to alter 
the wine. 

One after another followed Pasteur's 
intensive researches into difficult prob' 
Iems of national importance. He was 
first called upon to solve the mystery 
of the silkworm disease which was 
ruining the silk industry of France. 

Pasteur solved the problem, found 
a remedy, and restored an industry. 
I le then attacked the disease anthrax, 
which was ravaging the herds of cat' 
tie and destroying the leather indus' 
try. He demonstrated again the bacil' 
Ius of anthrax, and furnished the cure for the disease. Hog 
cholera and chicken cholera then claimed his attention. 
Again he put his finger on the weak spot, and announced a 
cure. Finally the triumphant conquest of hydrophobia was 




MODEL OF A TARTRATE 
CRYSTAL MADE AND USED 
BY PASTEUR. HEIGHT 8 
INCHES 



proclaimed. Though the bacterium which causes hydropho- 
bia has not yet been discovered, its existence is assumed, 
and, based on that assumption, his remedy — the only suc- 
cessful remedy — has been applied. 

His researches and proofs banished forever the claims of 
most of the scientists of his time, in favor of spontaneous 
generation of life. 



MME. MARIE CURIE 



MME. MARIE CURIE 



THE fifth memento is an instrument of precision, 
devised by Prof. Pierre Curie, at the Sorbonne in Paris, 
and used by him and by Mme. Curie. It was employed to 
determine the strength of electron discharge from radium, 
which Mme. Curie had just discovered by an ultra-scientific 
piece of detective work, little less than a romance. 

This instrument illustrates, also, another discovery which 
Prof. Curie was elaborating before that time, namely, the fact 
that crystalline substances, when compressed or expanded, 
emit electrons, due to the strain put upon them. In this 
instrument there is a long slice of a quartz crystal, held by 
one end and weighted at the other. An electroscope, placed 
opposite the face of the crystal records the discharge of 
electrons, in exact proportion to the weight put upon it. 
This is known as the "Quartz-piezo-electric" apparatus. 
This very instrument was used by the discoverer of radium 
in her early work, and is presented to the College of Physi- 
cians by Mme. Curie in response to an appeal for a souvenir 
of her work. It may almost be said to be the first instrument 
ever made actually to weigh, as it were, the smallest divisions 
of the atom, the electrons. To view this instrument is to be 
enthralled by the spirit of research which its personality 
inspires. 



Translation* of Mme. Curie's Description of the 
Apparatus She Gave to the College of 
Physicians, Philadelphia 
In this apparatus is utilized the property which crystals of 
quartz possess of acquiring an electric polarization following 
a deformation. 

This phenomenon of " Piezo electricity" thus manifested 
in quartz was discovered by Pierre and Jacques Curie and 




MME. CURIE SEATED BEFORE A MODIFIED QUARTZ'PIEZO ELECTROMETER (1921 ) 

recognized not only in quartz but generally in all crystals 
not having a center of symmetry. 

The lamina of quartz used in this apparatus has a thickness 
of about one-half millimeter. Its surface is perpendicular to 
one of the three binary axes of the crystal. It is a rectangle 
whose shorter side (about fifteen millimeters) is parallel to 
the third optic axis, so that the longer side (six to ten centi- 
meters) is perpendicular to this axis. The two ends of the 
* Translation by Prof. A. W. Goodspeed 



lamina are fixed in clamps of whic h one is used to suspend the 
lamina while the lower clamp carries a pan in which weights 
can be placed. When the pan is loaded there is exerted on the 
crystal a tension in a direction at once perpendicular to the 
third axis and to the second axis. This tension has the effect 
of setting free on the two faces of the lamina quantities of 
electricity equal and opposite in sign which it is the purpose 
to collect. For this the two faces of the lamina are covered 
with tinfoil or a deposit of silver. These conducting armatures 
are insulated by grooves placed opposite each other at the 
ends of the lamina. One of the armatures is connected with 
the earth while the other is insulated. When a weight is 
placed on the pan a definite quantity of electricity and of a 
given sign is set free on the insulated armature. This quantity 
" q" is proportional to the stretching weight F; it is expressed 

klF 

by the formula q = — where / is the length of the lamina, e 
the thickness of it, and k the piezo electric modulus for quartz. 

When the weight F is lifted the quantity of electricity set 
free on the insulated armature is equal and of opposite sign 
to that which is obtained in putting the weight on. 

Such a lamina which is really a very constant electric 
standard may serve to measure currents of feeble intensity 
such as those which are produced in ionization chambers by 
radioactive substances. For this purpose the insulated 
armature is joined to one of the quadrants of an electrometer 
the other one being grounded. The insulated quadrant is also 
attached to the source of electricity which produces the 
current that is to be measured (for example to the insulated 
electrode of the ionization chamber). 



One can compensate very exactly the current to be meas- 
ured and keep the electrometer at zero by lifting gradually a 
weight F put on the pan. The current strength i is given by 
the formula i = J, where t is the time measured by a chro- 
nometer during which the current i has been compensated 
by the raising of the weight F. Thus this current i can be 
known in absolute value with great precision. 

This way of measuring was used continuously by Pierre and 
Jacques Curie in their researches on feebly conducting bodies. 
I used it afterwards in my researches on the radiation from 
compounds of uranium and of several other substances. 
Later we have constantly used it, Pierre Curie and I, in the 
measurement of radioactivity made necessary by the new 
method of chemical analysis which has served us in the 
separation of the new radioactive substances, radium and 
polonium. 

It can be concluded then that this method of measurement 
has rendered very great service. 

The piezo-electric quartz apparatus is still continuously 
used in the Curie laboratory. It is employed by the investiga- 
tors and by the students who easily learn its use. The 
magnitude of the currents which can be thereby measured 
varies within wide limits. 

The apparatus which I offered to the Cabinet of the 
College of Physicians of Philadelphia is one of the first 
models made. It is one of two which were used by us in our 
associated work during the first years of our researches on 
radioactivity. 



Venerable But Vigorous: The College 
of Physicians 1 



7iv LUCINDA P. R< >SJ 



Till large, red-brick building on 22nd 
Street, just below M.uket, holds 
within its walls a profusion of won- 
derments, including a museum, a library, 
the meet in» hall for a soc iety that has been 
in existence since 1787, and oil paintings 
by Gilbert Stuart, Eakins anil Sargent. But 
few Philadelphians outside the medical and 
pharmaceutical professions have visited 
The College of Physicians of Philadelphia 
or know anything about the wealth of in- 
teresting material housed within its build- 
ing. 

And without, for even the garden beside 
the building is not an ordinary one, but a 
medicinal herb garden (Figure 1). By tak- 
ing .1 walk along its paths, you find out that 
Mother of Thyme is a cure for nightmares, 
Rosemary for asthma, and should you want 
to induce perspiration, try a bit of Lemon 
Balm. Responsible for maintaining this 
plot of edifying greenery is the Philadelphia 
Unit of the Herb Society of America. The 
garden is open to the public — they ask only 
that you leave it as you find it. 

The Mutter Museum, located within the 
College building, is a place you may want 
to leave the minute you find it. However, 
with a strong stomach and strong will- 
power, you can spend several hours in the 
museum and still not take it all in. The 
executive director of the College, Dr. W. 
Wallace Dyer, characterizes the museum as 
being "unusual in its variety." This seems 
like an nuclei statement. Along with the 
to-be-expected collections of pickled loeti, 

'This article appeared in Delaware Valley 
Calendar in September 1908. It is reprinted here 
with permission of the Editor-Publisher at the 
request of the- Council of The College of Physi- 
cians. 

2 A free lance writer. 



skeletons and skulls are collections of eye- 
glasses, shoes and thermometers. More grisly 
items include shrunken heads and a wallet 
made ol human skin (given l>v an anony- 
mous donoi i . 

II you are a celebrity seeker, you may 
want to look at a piece of John Wilkes 
Booth's thorax, the bladder calculi re- 
moved from duel Justice- John Maishall, 
or the plaster cast of Chang and Eng 
Bunker, the famous Siamese twins. I hen 
there is the- upper right jaw of President 
Cleveland, complete with seveial teeth, or, 
for the ladies, Florence Nightingale's sew- 
ing-kit. 

One thing you're not likely to miss in the 
museum's helter-skelter is the skeleton ol a 
giant, seven feet six inches tall and simply 
labeled as "a young man from Kentucky." 
Equally eye-stopping is the bod) of the 
"petrified lad" — the adipocere body of a 
Mrs. Ellenbogen, which is casually laid out 
in the open on a slab in one of the rooms 
and more awesome than a mummy in the 
University Museum. 

Although most ol the museum is con- 
centrated in five or six looms, other memo- 
rabilia are placed In cases throughout the 
building. Particularly notable is the collec- 
tion in the second floor hallwav which 
includes Benjamin Rush's gold watch (re- 
putedly still in working condition): an ink- 
stand and lock of hair belonging to Edward 
Jenner (the discoverer of vaccination): an 
instrument used bv Pierre Curie to study 
radioactivity shortly after its discovery, 
<alled the "quartz-piezo-electric" and 
donated to the College by Marie Curie; 
Joseph Lister's carboli< acid spray from his 
early days of antiseptic surgery; and a 
model ol tartar crystal made by Louis 
Pasteur. 



243 



2! 1 



LUCINDA P. ROSE 




1. The herb garden of The College of Physicians. 



Of these famous men, Benjamin Rush, 
signer of the Declaration of Independence, 
was the one most intimately associated with 
The College of Physicians, heing, in fact, 
one of its founders. Other founders in- 
cluded John Morgan, William Shippen, 
Samuel Dufheld, John Jones — all famous 
figures in the early Philadelphia medical 
scene. 

The College was founded not as a college 
in the sense of an educational institution, 



but rather as a "collegium" — a society of 
colleagues. Its prototype was the Royal Col- 
lege of Physicians of London. Fellows of the 
College were to be elected "without any 
regard to Diversity of Nation or Religion" 
according to the words of the founders. 

During its early years the College was 
often called upon to give advice on public 
health matters, especially during the epi- 
demics of yellow fever at the turn of the 
18th Century. The College still maintains 



V1.M.R MU 1 Ut I VK.OKOl s 



245 



.in at t i \ t- interest in public health. For ex- 
ample, recent meetings have included Mil) 
jects such as aii pollution and hallucino- 
genic drugs. 

Now numbering almost I 100 Fellows, the 
College provides a common meeting ground 
lor all the medical schools, hospitals and 
leaders in the medical profession in the 
Philadelphia an a. Members inc hide women 
as well as men. The endowed monthly lec- 
tures are usually published in the College's 
quarterly journal. The Transactions and 
Studies of The College of Physicians of 
I'hiladel()liia. the first issue of which was 
pi tnted in 1 1 1 1 x 1 793. 

Perhaps most important of all to College 
Fellows, as well as to the area's medical pro- 
fession at large, is the extensive medical li- 
brary maintained bv the College. The li- 
brary contains almost a quarter million 
volumes and subscribes to .1200 medical 
journals in connection with which it pro- 
vides scanning, indexing, abstracting and 
translating services. It also has a Rare Book 
Department, including 416 incunabula 
(books printed before 1500) and eight medi- 
eval manuscripts. 

Started in 1788 with the donation of 
twenty-four volumes by John Morgan, the 
library now ranks as the third or fourth 
largest of its kind in the country. It is used 
widely bv medical students, historians, 
lawyers, advertising firms, pharmaceutical 



and other industrial dims, and many others 
who have occasion to do medical research. 
It lias Ik i n named a regional medical li 
bran, related to the National Library of 
Medicine in Washington. 

Lining the walls of library, hallway and 
meeting room are the over sixty paintings 
in the College collection. Most of these are 
portraits ol Philadelphia physicians who 
were Fellows of the College. Some of the 
artists are well-known, including Thomas 
Eakins, John Singer Sargent, Thomas 
Sully, Gilbert Stuart and Rembrandt Peale. 

Many of these portraits are hung in 
Mitchell Hall, the large, handsome, wood- 
panelled room in which the monthly meet- 
ings of the College are held. One Fellow has 
described these meetings as the "stuffiest" 
he has ever seen; another describes them as 
"prestigious." These impressions may be 
fostered in pari h\ the fact that those who 
preside over the meetings wear academic 
robes. In any case, the meetings are con- 
sider abl) enlivened by the erudite w ittic isms 
of the current President, Dr. Francis C. 
Wood, former chairman ol the Department 
of Medicine of the University of Penn- 
sylvania. 

The College of Physicians is a venerable, 
but still very vigorous institution, and well- 
worth a visit from the medical-information 
seeker, the art student, the curiosity seeker 
or herb-garden fancier. 




246 



The Council <>l I he ( olli ge ol Physicians of Philadelphia, 1969 

(Left to right) Front How: T. Griei Miller, George I. Blumstein, Francis C. Wood, George 
A. Hahn Second Row: Samuel \ Raclbill. David A. Cooper, Elizabeth Kirk Rose, Donald M. 
1'illsburv, Gonlon \. French, Esmond R. Long, John L. McClenahan, Alfred M. Bongiovanni, 
John H. Gibbon, Jr., Fred B. Rogers, Robert Erwin Jones, Paid Nemir, Jr. (Absent from 
photograph) Lcroy E. Burney, Thomas M. Durant, Kendall A. Elsom, Peter A. Herbut, 
William P. T. Kellow, Richard A. Kern, Robert S. Pressman, Jonathan E. Rhoads, Truman G. 
Schnabel, Katharine R. Sturgis. 



247 




248 



The Staff of The College of Physicians, 1969 

(Left to right) Front Row: Mrs. Helen M. Reaney, Mrs. Ella N. Wade, Miss Alberta D. 
Berton, Mrs. Beatrice F. Davis, Elliott H. Morse, Miss Olga E. Lang, Mrs. Lisabeth M. Hollo- 
way, Walton Brooks McDaniel, 2d. Second Row: Miss Josefa Sereda, Miss Thea Fischer, Gilbert 
Bey, Miss Julianne Gable, Mrs. Pearl Stark, Mrs. Catherine Ledwell, Mrs. Juneann Lauder- 
bach, Mrs. Marybeth Leary, Alfred G. Lisi, Miss Mildred Gray, Miss Yoshi Nakayama. Third 
Row: W. Wallace Dyer, Mrs. Elizabeth Wright, Mrs. Donna Parks, Mrs. Ann Schor, Mrs. 
Sarah Caspari, Mrs. Kathryn Miragliotta, Miss Evelyn Huber, Dennis Dougherty. Fourth Row: 
Miss Linda S. Frantz, Miss Linda Justice, Mrs. Eleanor Taylor, Miss E. Noami Frazer. 
Fifth Row: Miss Anne McGinnis, Miss Dagmar Nemecek, Mrs. Judy Barnes. Sixth Row: Miss 
Valerie Suber, Mrs. Rhea Brown, Mrs. Christine Balonis, Mrs. Michele Winters. Seventh Row: 
Miss Carol C. Spencer, Mark Mattson, A. Male. Eighth Row: Miss Florence Fritz, Miss Grace 
Rupertus, Miss Andrea L. Jancsura, Miss Elizabeth Bertram. Ninth Row: Timothy Phillips, 
Mrs. Lynn Langdon, Mrs. Carol Stills. Tenth Row: Miss Margot van Rossum, Miss Lee J. 
Tanen, Miss Jean Carr, Carmine Salvato. Eleventh Row: Russell Campbell, James Bolton, 
James M. Gavin, Theodore Kolodziejski. 



249 



New Fellows of The College of Physicians of Philadelphia 

Elected 1969 



Name 



Place/Date of Birth 



1. Bannett, Aaron D. 

2. Baronofsky, Ivan D. 

3. Belmont, Herman S. 

4. Birtwcll, William M. 

5. Blocklyn, Maurice J. 



6. Bryant, Winston M. 
Jr- 



7. Buchheit, William 

8. Chesnick, Reuben B. 

9. Cohen, Erwin A. 

10. Davidson, Jay H. 

♦ 

11. Denbo, Elic A. 



Phila., Pa. 
7-12-23 



New York, N. Y. 
12-12-17 



Phila., Pa. 
3-13-20 



Ridley Park, Pa. 

9- 19-35 
Paris, France 

10- 14-12 

Brooklyn, N. Y. 
7-9-29 



Donara, Pa. 
10-14-33 

Haddonfield, N. J. 
1-15-09 



Phila., Pa. 
4-8-25 



Phila., Pa. 
4-12-18 

Camden, N. J. 
10-3-08 



12. Desiderio, Vincent C. 

13. Dolphin, John M. 

14. Dzwonczyk, John, Jr 



Phila., Pa. 
7-4-26 

Mahanoy City, Pa. 
11-28-23 
Dunmore, Pa. 
10-22-27 



Medical School 



Present Position 



Jefferson '46 



Marquette U. 
'43 

U. of Pa. '43 



Temple U. '60 
U. of Pa. '37 

Meharry '60 

Temple U. '60 
Jefferson '36 

U. of Pa. '48 

Temple U. '43 
Jefferson '33 



Hahnemann 
'53 

Hahnemann 
'47 

Hahnemann 
'54 



Assoc., Surgery & Chief Consul- 
tant, Vascular Surgery, Einstein 
(N); & Head, Organ Transplan- 
tation Unit, Einstein (N). 
Chairman, Dept. Surgery, Hahne- 
mann; Research Assoc. Scripps 
Clinic and Research Foundation. 
Prof. & Head, Section on Child 
Psychiatry; Member Advisory 
Committee on Child Planning to 
State of Pa. Commissioner on 
Mental Health. 
Section, Rheumatology & Asst. 

Prof. Med., Temple. 
President, Med. Staff, Crozer- 
Chester Hosp., Dept. Radiology, 
Crozer-Chester and Taylor Hosps. 
Surgeon, Ophthal., Mercy-Doug- 
lass; Instr., Ophthal. Temple; 
Asst. Surgeon, Wills; Ophthal.. 
St. Christopher's. 
Instr., Neurosurgery, Temple; Asst. 
Attending Neurosurgery, St. 
Christopher's. 
Assoc. Radiologist, VA Hosp.; 
Radiologist, Camden Cyt. Gen & 
Camden Cty. Chest & Camden 
Cty. Psychiatric Hosps. 
Clinical Instr., Temple; Adjunct, 
Einstein (N); Staff Surgeon at 
Rolling Hill, Oxford and Ken- 
nedy Memorial Hospitals. 
Assoc., Gastroenterology, Einstein 
(N); Director to 1968 Med. Edu- 
cation at St. Luke's & Children's. 
Chief Neuropsychiatrist, Cooper 
Hosp.; Chief, Neurology, W. 
Jersey Hosp.; Assoc., Neurology, 
Grad. Hosp.; Assoc., Psychiatry, 
Phila. Psychiatric Center; Assoc., 
Neurology, U. of Pa. Grad. Sch. 
Med. & Jefferson Med. 
Sr. Clin. Instr., Gastroenterology, 
Hahnemann; Assoc., Int. Med., 
St. Agnes. 
Staff & Assoc. Prof., Pathology, 

Hahnemann. 
Instr., Surgery, Hahnemann; As- 
soc., Surgery, Fitzgerald Mercy; 
Attending in Surgery, Miseri- 
cordia. 



250 



NEW FELLOWS 



251 



Name 



15. Ganz, Michael A. 



16. Gardiner, George C. 



17. Gehring, David A. 



18. Gellhorn, Alfred E. 

19. Goldman, Leonard 

20. Haase, Gunther R. 



21. Hanson, Stephen M. 

(Non-Resident) 

22. Harrell, George T., 

Jr. (Non-Resident) 

23. Hollender, Marc 

24. Kain, Thomas M., Jr 



25. Kissick, William L. 



II (Non-Resident) 
27. Klinghoffer, Leonard 



28. Koblenzer, Peter J. 



Place/Dale o] Birth 


Medical School 


Hartford, Conn. 


U. of Ottawa 


10-20-34 


'60 


Bridgeport, Conn. 


Tufts U. '61 


8-17-35 




Bryn Mawr, Pa. 


U. of Pitts- 


12-6-30 


burgh '56 


St. Louis, Mo. 


Washington U. 


6-4-13 


(lit 1 filllc^ 




'37 


N.J. 


Univ. Western 


3-4-30 


Ontario '55 


Chemnitz, Germany 


'^Q-Ludwig"- 


9-30-24 


\T 21 IT 1 mill TTK 




I I Tl 1 \'fr<:t T t 




Munich 


Los Angeles, Calif. 




8-18-24 


'48 


Washington, D. C. 


Duke U. '36 


6-16-08 




Chicago, 111. 


U. Illinois '41 


12-19-16 




Camden, N. J. 


Jefferson '43 


2-16-17 




Detroit, Mich. 


1 die vj / 


7-29-32 




Phila., Pa. 


U. of Pa. '42 


5-6-15 




Phila., Pa. 




1 1 -30-27 




Munich, Germany 


London '51 


12-6-22 





Present Position 



Staff Psychiatrist, Sidney Hillman 
and Gloucester Cty. Psychiatric 
Centers. 

Instr. Med., U. of Pa. Med; Asst. 
Attending Physician, PGH; Jr. 
Attending Physician and Chief, 
Inhalation Pulmonary Function, 
Mercy-Douglass Hosp. 

Attending, Int. Med., Underwood 
Memorial (Woodbury); Consul- 
tant in Cardiology, Elmer Com- 
munity Hosp. (N. J.) ; Staff, Edge- 
wood Div., W. Jersey Hosp. 
(Berlin, N. J.). 

Dean and Director and Prof., Medi- 
cine & Pharmacology, U. of P 
Med. 

Asst. Prof., Surgery, Temple 

Sr. Attending Physician, PGH; 
Dept. Neurology, Temple. 



Pathologist, Coatesville Hosp.; In- 
str., Pathology, Temple. 

Dean, and Prof. Med., Pa. State U. 
and Dean, Hershey Med. 

Prof., Psychiatry, U. of Pa. Med. 

Chief, Dept. Med. & Assoc., Cardi- 
ology, Cooper Hosp.; Asst. Prof. 
Clin. Med., Jefferson; Attending 
Staff Physician, Our Lady of 
Lourdes. 

Prof. & Chrmn., Dept. Community 
Med., U. of Pa. Med.; Appa- 
lachian Regional Commission 
Health Advisory Committee; 
Sloan Inst., Cornell U. faculty; 
World Health O., advisor; Con- 
sultant, Social Rehabilitation 
Service (MEDICAID). 

Assoc., Staff, Monroe Cty. Gen. 
Hosp. (Stroudsburg) 

Assoc. Prof., Orthopedic Surgery, 
U. of Pa.; Adjunct Prof., Ortho- 
pedic Surgery, (N) Einstein. 

Assoc., Pediatrics & Derm., U. of 
Pa. Grad. Sch. Med.; Assoc., 
Physician, Children's & Rancocas 
Valley Hospitals; Assoc. Physi- 
cian, Burlington Cty. Memorial 
Hosp.; Consultant, Pediatrics 
Pa. Hosp. 



252 NEW FELLOWS 



Name 


Place/Dote of Birth 


Medical School 


Present Position 


29. Lentz.JohnW. 


Phila., Pa. 


U. of Pa. '37 


Chief, Dermatology, Lankenau; 
Asst. rrot. Dermatology, Jener- 
son Med. 


30. Lcto, Francesco 


Catanzaro, Italy 


U. of Naples 


Adjunct Prof., Int. Med., Einstein 




7-20-25 


'55 


(N); Assoc. Prof., Int. Med., St. 
Agnes. 


31. Lightfoot, William P. 


Pittsburgh, Pa. 
9-12-20 


Howard '46 


Assoc. Prof., Surgery, Temple 


32. Mallin, Aaron W. 


Phila., Pa. 
10-16-13 


U. of Pa. '39 


Assoc., Neurology, U. of Pa. Med.; 
Instr., Ncur. & Psych., U. of P. 
Grad. Sch. Med. ; Chief, Neuro- 
psychiatry, Mercy-Douglass & 
Amer. Oncologic Hosps. ; Neu- 
rologist, Univ. Hosp. at PGH & 
Einstein; Neuropsychiatrist, 
Grad. Hosp; Psych., Phila. Psych. 
Cntr. & Northwestern Mental 
Health Center. 


33. Mansure, Frank T. 


Lansdowne, Pa. 
7-24-26 


U. of Pa. '53 


Out-patient Physician, Prcsby- 
terian-U. of Pa. Med. Cntr. 


34. Mansure, Patricia R. 


Phila., Pa. 

\\J-ZZ-Z\3 


Woman's '55 


Asst. Medical Director, Fidelity 
Mutual Life Insurance Co. 


jj. Marks, oerald 


Brooklyn, N. Y. 
4-14-25 


Jellerson 4y 


Asst. Surgeon & Instr., Surgery, 
Jefferson Med.; Asst. Chief of 
Surgery, PGH; Consultant, Proc- 
tology, Coatesville VA Hosp. 


36. Morris, Robert G., 


Winston-Salem, N. C. 


Howard '48 


Director, Radiology, Mercy-Doug- 


Jr. 


4-9-24 




lass; Acting Med. Director, 
Mercy-Douglass. 


37. Myers, Eugene N. 


Phila., Pa. 
1 1 -27-33 


Temple U. '60 


Asst. Prof., Otolaryngology, U. of 
Pa. Med.; Attending in Oto., 
Presbyterian-U. of Pa. Med. 
Cntr. 


38. Rawnsley, H. M. 


Long Branch, N. J. 
1 1 -20-25 


U. of Pa. '52 


Acting Dir., Clinical Research, U. 
of Pa. Med. ; Member, VVm. rep- 
per Lab.; Consultant, Clinical 
Path., Phila. Naval & VA Hosps.; 
Assoc. Prof., Clin, rath., U. ot 
Pa. Med. 


39. Relman, Arnold S. 


New York, N. Y. 
6-17-23 


Columbia '46 


Prof, and Chairman, Dept. Med. 
U. of Pa. Med.; Chief of Med. 
Service, U. of Pa. Hosp. 


40. Robinson, Nathaniel 


St. Matthews, S. C. 


Marquette '54 


Med. Consultant, Psychiatry, PGH; 


M. 


7-20-25 




Director, Med. Clinics & Sr. At- 
tending Physician, Mercy-Drug- 
lass Hosp. 


41. Rodgers, Robert A., 


E. Liverpool, Ohio 
4-17-25 


Hahnemann 


Asst. Obstetrician - Gynecologist, 
Pa. Hosp.; Assoc., Obstet.-Gyn., 
Underwood Memorial Hosp. 
(Woodbury) . 


42. Roediger, Paul M. 


Princeton, N. J. 
6-30-32 


Jefferson '58 


Director, Med. Education and Asst. 
to Chief of Staff, Abington. 


43. Rosato, Francis E. 


Phila., Pa. 


Hahnemann 


Assoc., Surgery, U. of Pa. Hosp; 




6-2-34 


'59 


Consultant in Surgery, VA; At- 
tending in Surgery, PGH. 



NEW FELLOWS 



253 



Name 


Place/Date of Birth 


Midical School 


Present Position 


44. 


Rowland, Lewis P. 


Mew Vnrl- N V 
1 N ( W I OI K , 11 . I . 

8-3-25 


Yale '48 


Pt"(»f R.' f!h a i rn 1 a ti N*Mirnlni'V 1 
l I \)i . tx UUWI 1 1 1 <i 1 1 , i^t. m kji itf^ y , \J . 

(if Pa \/ff'ri ■ AttrnfliiMr NfMiroln- 

gist, Columbia-Presbyterian Med. 
Center 


45 


Schaedlcr, Russell W. 


T T 1 1 Ti *> ! rl Pa 

i l . 1 1 1 1 ' M i a. 


JcfTerson 53 


1 K-(U1 , 1 ' 1 . 1 IV 1 1L. I KjiJ 1 1 1 ■ 1 V OC I I Ul ■ 




W. 


12-17-27 




\1 i r* r ol ii ol of* v I #* rcon rvl f*H 


46 


Sewell, Edward M. 


Phila., Pa. 
5-21-23 


U. of Pa. '47 


Sr. Physician & Chief, Chest Dis- 
eases, Children's; Asst. Prof., 
Pediatrics, U. of Pa. Med. 


47. 


Silberberg, Donald 


W ;i ch i iict f on 1) \. 


T of \A irhifran 


Assoc. Prof., Neurology, U. of Pa. 




H. 


3-2-34 


'58 


Med.; Consultant, Children's & 
VA hosps.; Consulting Neurosur- 
geon at Doylestown & Phocnix- 
ville Hosps. 


48. 


Skvcrsky, Norman J. 


Phila Pa 
i [lli.i, i . i 

7-7-15 




•\ttf»I10ltl(> lMlVvl/'I'ITl IVl'llthlT'l 

. ilHHUlllL; 1 liyMtldll, I CllUUCIdl 

Va^r 1 1 1 7\ r X linn Finctpin f^Ji Ri 

V dSv Ul "I 0\_v.UUll, 1— < 1 I J a LC 111 \ 1 'I / oc 

Moss Rehabilitation; Clinical 

A cct Prnf oi vJ\ ft\ i/'riiol/*' 1 'on - 
\ 1 I I Ul . Ul IVltU, , 1 ' ...\>.< , V-^Ull" 

siil t 'in t Pni 1 9 1,/t i 'a I r i r* it* nl/r 
Ml .I.M. I M 1 . . 1 v.J ( 1 . . 1 , 1 t v_vt.. Hi' I 


49. 


Stewart, W. Wayne 


L-J ti y lull) V^DIU 


T-I ^inn/*ui Qnn 

n .iiiii' 1 1 1 . 1 1 1 1 1 


R ^cf^rrn T* f*l I ow T inlo**n;*ii - C'on - 






10-31-17 


'43 


sultan t Industrial Med. Ch ester - 
Crozer; Staff, Hahnemann. 


50. 


Taylor, W.J. Russell 


Winnipeg, Manitoba, 


U. ofManitoba 


Assoc. Prof., Hahnemann; Director, 






Canada 


'56 


Clinical Pharmacology -Toxi- 






5-6-30 




cology, PGH. 




Waugh, Bascom S. 


Glade Springs, Va. 
12-9-08 


Meharry '35 


Assoc., Clinical Med., Jefferson; 
Director, Stroke Rehabilitation 

Pnnnpr T~i ocn 


52. 


Weibel, Robert E. 


r q ti t n n l-* q 

- ■ i i . 1 1 1 1 ( 1 1 1 , r a. 

12-9-29 


TT nf Pa "i"! 


App nr P^ i riisitrtr , c II ot P n \j1 f*o 
. »;>:» UC. 1 CUlall ILd, vJ. Ul 1 a. ivi CU. , 

Pediatrician, Bryn Mawr & Lan- 
kenau; Assoc. Physician, Chil- 

U I V. 11 3 1 lUbU. 


53. 


Whitman, Mark A. 


Phila., Pa. 


Hahnemann 


Chief of Service, Germantown 






6-4-22 


'47 


T4 ncn AftpnHinn" Pf*H i n t r ir? 

Chestnut Hill; Sr. Instr., Pediat- 
rics, Hahnemann Hosp. 


54. 


Williams, James R. 


Bryn Mawr, Pa. 
4-21-24 


Meharry '55 


Director of Pathology, Mercy- 
Douglass Hosp. 


55. 


Wouters, Freerk W. 


Atlanta, Georgia 
9-23-28 


Emory '53 


Assoc. Clinical Psychiatrist, Jeffer- 
son; Staff Psychiatrist, Friends 
Hosp.; Consultant, St. Vincent's 
Hosp. 


56. 


Yanoff, Myron 


Phila., Pa. 
12-21-36 


U. of Pa. '61 


Assoc. Ophthalmology, U. of Pa.; 
Asst. Ophthal., Children's & VA 
Hospitals. 



Memoir of Delazon Swift Bostwick 
1893— 1968* 

By HERBERT J. DIETRICH, JR., M.D. 



DELAZON Swift Bostwick, elected a 
Fellow of The College of Physicians 
of Philadelphia in 1936, was born 
on November 30, 1893, in Sheridan, Wyo- 
ming, the son of a Congregational minister. 
He died November 27, 1968, a few days be- 
fore his 75th birthday, at Methodist Hos- 
pital, Philadelphia, with which institution 
he was closely associated throughout his en- 
tire professional life, which spanned 47 
years. 

Following his graduation in 1921 from 
the School of Medicine of the University of 
Pennsylvania, Dr. Bostwick interned at 
Methodist Hospital where he then served 
four years as chief resident physician and 
surgeon. He thus acquired a broad knowl- 
edge of general medicine and surgery, which 
was always apparent in the high quality of 
his later work in the specialty of otolaryn- 
gology. From 1926 onward, he was continu- 
ously associated with the Department of 
Otolaryngology, through successive staff ap- 
pointments to that of Chief of the Depart- 
ment; he had the rank of Emeritus Chief at 
the time of his death. He was also Associate 
in Otolaryngology at the Hospital of the 
University of Pennsylvania and School of 
Medicine. 

Dr. Bostwick had tremendous respect and 
admiration for his seniors, and he counted 
it a high privilege, in the best Hippocratic 
tradition of medicine in this city, to work 
under such stalwarts as the late Dr. Walter 
Roberts, one of the very top otolaryngolo- 
gists of his day — or any day for that matter. 
Equally, his personal relationships with his 
peers, residents, nurses, interns and admin- 
istrators were characterized by sincere re- 

* Prepared and published at the request of the 
Council of The College of Physicians of Philadel- 
phia. 



spect and unfailing kindness. In turn, they 
all became his devoted friends. In memo- 
rializing Dr. Bostwick, the Methodist Hos- 
pital News said of him: "Dr. Bostwick was 
an outstanding physician and will be re- 
membered by many for his professional 
accomplishments. But at Methodist Hos- 
pital he will be remembered above all as a 
gentleman — for he was in truth a gentle 
man. His gracious manner and unfailing 
courtesy will be greatly missed in the insti- 
tution he served so well." 

In addition to certification by the Ameri- 
can Board of Otolaryngology (1932), Dr. 
Bostwick was certified by the American 
Board of Preventive Medicine (1953) in the 
specialty of Aviation Medicine. He was is- 
sued a private pilot's license in 1931. He 
piloted his own plane and had logged over 
4000 hours of flying time. 

His skill as an otolaryngologist, coupled 
with his love of aviation, enabled him to 
contribute measurably to the development 
of aerospace medicine. Indeed, he played 
a major role in the evolution of this spe- 
cialty, serving at various times as a faculty 
member of Federal Aviation Medical Semi- 
nars where he presented "Otolaryngological 
Aspects of Aviation Medicine." He was one- 
time President of the Civil Aviation Medi- 
cal Association; he was Vice President and 
member of the Executive Council of the 
Aerospace Medical Association, chairing 
and serving on numerous committees 
throughout the years and receiving in 1964 
the Association's award for outstanding con- 
tribution to the art and science of aviation 
medicine in its application to the general 
field of aviation. In 30 years, he missed only 
one national meeting of the Aerospace 
Medical Association. 

He was internationally known in this 



254 



MEMOIR OF DELAZON SWIFT BOSTWICK. 



255 



field, with friends among flying physicians 
in every country of the world. In 1959, he 
attended the International Congress of Avia- 
tion Medicine in Rome and was a delegate 
to the Flight Safety Foundation seminar in 
Nice. 

In Philadelphia, Dr. Bostwick was once 
featured on the TV Cavalcade of Sports 
program as the winner of the Wings Field 
Regatta, an air race scored on speed, effi- 
ciency and navigation. 

In addition to numerous societies having 
to do with Aviation Medicine, Dr. Bostwick 
was a life member of the American Medical 
Association, the Pennsylvania State and 
Philadelphia County Medical Societies, the 
American College of Surgeons. He was also 



a member of the Union League of Philadel- 
phia and the Merion Golf Club. 

Dr. Bostwick, having married rather late, 
was richly blessed in his wife, Hannah 
Stretch Bostwick, who fully shared all of his 
interests in life. She was at one time his 
nurse anesthetist, equally devoted to the 
welfare of the patients. She later became his 
enthusiastic companion of fireside, skyways 
and fairways. 

Delazon Bostwick, as a physician who 
figuratively always had both feet on the 
ground and as a sportsman who soared 
above terrestrial cares, enjoyed it all. He 
would have agreed with Robert Louis 
Stevenson, who said in The Lamplighters: 
"To miss the joy is to miss all." 



Memoir of Theodore Cianfrani 
1899-1968* 

By JOSEPH H. ZEIGERMAN, M.D. 



THEODORE Cianfrani excelled in 
both art and medicine. It was Erwin 
F. Faber of the University of Penn- 
sylvania who in 1951 encouraged him to 
paint in oil. Since that time, he worked in 
one media or another whenever he had time 
to spare from his busy practice. Ted had a 
vast knowledge of art. He read many books 
on the subject and knew the fundamentals 
of painting as well as the artistic aspect. He 
found it relaxing and fascinating. He has 
done medical illustrations, pen and ink 
drawings, oils, etchings, water colors and 
a handful of pencil sketches. He did all of 
them well. 

He studied art for a brief period of time, 
etching with the late Earl Horter, oils with 
the late Paul Martel, a life class with Herr 
Heymann in Munich, Germany, a life class 
in oils with Joseph J. Coppolino and por- 
trait painting with Caesare A. Ricciardi. 

Examples of his work hanging in the 
School of Medicine of the University of 
Pennsylvania are portraits of Dr. Harry 
Paul Schenck and Dr. Francis Grant. Por- 
traits hanging at Graduate Hospital are of 
Dr. William Bates, Dr. Edmund Spaeth, Dr. 
Robert A. Kimbrough and Anita Porter 
Clothier. He painted a portrait of William 
J. Clothier, Sr., which is hanging in the 
Hunt Club. He also painted portraits of Dr. 
William R. Nicholson and Dr. Barton 
Cooke Hirst. 

Theodore Cianfrani was born in Phila- 
delphia on April 12, 1899 and died on No- 
vember 3, 1968. His parents were Domenico 
Cianfrani and Emilia Di Giacoma Cianfrani. 
He was married in 1936 to Ethel Emoline 

• Prepared and published at the request of the 
Council of The College of Physicians of Philadel- 
phia. 



Haas. He attended the University of Penn- 
sylvania (1917-9) and subsequently the 
School of Medicine of the University of 
Pennsylvania (1919-23). He took his intern- 
ship at Misrecordia Hospital (1923-4) and 
was assistant in Gynecology and Pathology 
at Howard Hospital (1924-8). He was As- 
sistant in Surgery and Instructor in Surgical 
Anatomy at Woman's Medical College Hos- 
pital (1924-8). He took post-graduate work 
at Doderlein Clinic, Munich, Germany 
(1932), and became connected with the 
Graduate Hospital and Graduate School of 
Medicine, University of Pennsylvania, where 
he taught Gynecology from 1928-66 and re- 
tired as Associate Professor in Gynecology 
and Obstetrics. 

He was Chief and Director of Gynecology 
at St. Agnes Hospital and Clinical Professor 
of Gynecology at Hahnemann Medical 
School and Hospital. He was an Associate 
in Obstetrics and Gynecology at Pennsyl- 
vania Hospital. 

He was a Diplomate of the American 
Board of Obstetrics and Gynecology, Fellow 
of the American College of Surgeons, Fel- 
low of the American College of Physicians, 
Fellow of the College of Obstetrics and 
Gynecology, member of the Philadelphia 
County Medical Society (serving on the 
Board of Maternal Mortality for many 
years), and a member of the American Medi- 
cal Association and Pennsylvania Medical 
Society. He was the author of A Short His- 
tory of Obstetrics and Gynecology and wrote 
15 papers in obstetrics and gynecology. 
Some of his better known articles are Neo- 
plasms in Apparently Normal Ovaries, 
Panhysterectomy without Vaginal Cleans- 
ing, and Endometrial Carcinoma after 
Bilateral Oophorectomy. 



256 



Memoir of Walter S. Cornell 
1877-1969 1 

By HERBERT W. CORNELL 2 



DR. Walter S. Cornell, for 31 years 
Director of Medical Services for the 
Philadelphia schools and later the 
(unsalaried) head of the Philadelphia 
Public S< hool Health Fund, died at the age 
of 92, on March 21, 1969, in the Presby- 
terian Hospital of Philadelphia after an 
illness of a few weeks. He will be especially 
remembered for his work in the field of 
public health and school hygiene. 

Walter S. Cornell was born in Phila- 
delphia on January 3, 1877, and was grad- 
uated from the then recently founded 
Northeast High School in 1893. At the time 
of his death, he was the sole surviving mem- 
ber of the school's first graduating class. He 
entered the University of Pennsylvania, 
receiving the degree of Bachelor of Science 
in 1897 when he had the memorable ex- 
perience of being on the same platform as 
his father, Watson Cornell, a Philadelphia 
school principal, who received a Ph.D. 
degree in that same ceremony, and who, at 
the time of his death in 1902, was State 
Director for Pennsylvania of the National 
Educational Association. 

Walter S. Cornell continued at the Uni- 
versity of Pennsylvania, entering the School 
of Medicine in 1897, receiving his M.D. 
degree in 1901 and also a degree of Doctor 
of Public Health in 1922. While at the Uni- 
versity, he had the distinction of being 
elected to membership in Phi Beta Kappa, 
to Sigma Xi, and to Alpha Mu Pi Omega 
(Medical). His medical internship was at 
the Presbyterian Hospital of Philadelphia. 

1 Prepared and published at the request of the 
Council of The College of Physicians of Philadel- 
phia. 

2 Mr. Cornell is the brother of Walter S. Cornell, 
M.D. His address is 5939 Drexel Road, Philadelphia, 
Pennsylvania 19131. 



Following his internship, he became a 
Lecturer in Anatomy and later in Hygiene 
at the University of Pennsylvania, and at 
the same time assisted on a part time basis 
as a school inspector in the city's Health 
Department. In 1912, the school medical 
work was transferred from the Health De- 
partment to a new department in the office 
of the Board of Education, and he was 
chosen as its first Director of Medical Serv- 
ices, an office which he held for 31 years. 
When, in 1943, he reached retirement age, 
he quit his salaried position but not his 
work for the School Board. He continued 
on a volunteer basis as the Director of the 
School Health Fund, a charitable fund 
raised by private contributions in which 
teachers and pupils in the schools partici- 
pated and to which Dr. Cornell's wife and 
some personal friends contributed very 
generously. The money which was raised 
was used to furnish to underprivileged chil- 
dren certain medical and dental services 
which cotdd not be allowed from the city's 
budget. Dr. Cornell continued in this work 
up to the time of his last illness. 

In addition to his teaching at the Uni- 
versity of Pennsylvania which continued 
until 1956, he also served as Assistant Pro- 
fessor of Public Health and Preventive 
Medicine at Temple University for several 
years. 

He held the offices of President of the 
Philadelphia County Medical Society, 
Chairman of the Public Health Section of 
The College of Physicians of Philadelphia, 
Chairman of the Section on Child Hygiene 
of the American Public Health Association, 
Chairman of the Medical Advisory Com- 
mittee of the Philadelphia Chapter of the 
National Foundation for Infantile Paralysis, 
and Editor of the Diabetic Digest of the 



257 



258 



HERBERT W. CORNELL 



Delaware Valley Diabetic Association. He 
also was a member of the American School 
Health Association, from which he received 
the Home Award, and of the Philadelphia 
Council of Boy Scouts, from which he re- 
ceived the Silver Beaver Award. He was a 
member of the Philadelphia Union League 
and was a Mason. 

During World War I, he served as a 
Colonel in the Army Medical Reserve 
Corps, and up to the time of his death he 
had membership in Benjamin Franklin 
Post #405 of the American Legion. 

Aside from his medical work, Dr. Cornell 
was greatly interested in two recreational 
charities for children, the College Settle- 
ment Farm Camp near Horsham, Pa., and, 



adjacent to it, the Kuhn Day Camp. The 
latter was founded and endowed by his wife 
in memory of her parents, Henry J. and 
Willemina B. Kuhn. These two children's 
camps operate together, and, although they 
are organized as separate corporations, they 
have unified control with the same people 
serving as Trustees in both organizations, 
and this naturally included Dr. and Mrs. 
Cornell up to tbe time of their deaths. They 
were married in 1922, Mrs. Cornell dying 
after a long illness in 1965. 

Dr. Cornell was a member since boyhood 
of the Girard-Welsh Presbyterian Church, 
and also, for his last decade, of the Over- 
brook Presbyterian Church. His residence 
was at 5939 Drexel Road, Overbrook. 



Memoir of Lewis Kraeer Ferguson 
1897-1968* 

By PAUL NEMIR, JR., M.D. 



ON Sunday, April 7, 1968, Dr. Lewis 
Kraeer Ferguson, master surgeon, 
distinguished teacher and author, 
and Fellow of The College of Physicians 
for 33 years, quietly passed away, after a 
protracted illness. 

Kraeer Ferguson was born in Allegheny, 
Pennsylvania, on April 29, 1897, the fourth 
son of Huber and Carolyn Kraeer Fergu- 
son. His father served as a minister of the 
United Presbyterian Church in Washing- 
ton, Pennsylvania, for many years. 

Kraeer attended Xenia High School in 
Ohio and in 1914 was admitted to West- 
minster College in New Wilmington, Penn- 
sylvania, where he made an outstanding 
record. It was during his stay at Westminster 
that he decided to go into medicine, rather 
than to follow in the footsteps of his father 
and grandfather in the ministry. 

During his last year at Westminster, he 
made application to the University of Penn- 
sylvania School of Medicine, and it is prob- 
able that at this time the first complication 
in his well-ordered life occurred. Early in 
December of 1917, he and 11 other mem- 
bers of the senior class at Westminster were 
called to the colors, and he was soon sent to 
France. His application was considered at 
Pennsylvania and early in 1919 Dean 
William Pepper wrote to the authorities at 
Westminster College, stating that there had 
been no mention in the application that 
young Ferguson had received credit for the 
course in organic chemistry. He pointed out 
that organic chemistry was required for 
admission to the University of Pennsyl- 

• Read before The College of Physicians of Phil- 
adelphia, 14 May 1969. Prepared and published at 
the request of the Council of The College of Physi- 
cians of Philadelphia. 



vania. Kraeer had apparently much im- 
pressed his teachers, for Professor Charles 
Freeman answered Dean Pepper's inquiry, 
as follows: "He did not complete the course, 
owing to the fact that he was called to the 
service of his country during the school 
year, but while he was in the class he was a 
most efficient and satisfactory student, and 
was granted the A.B. degree in absentia by 
the faculty at the commencement of 1918." 
He was admitted to the University of Penn- 
sylvania. 

Young Ferguson began his studies at 
Pennsylvania in 1919 and received his medi- 
cal degree in 1923. He continued his out- 
standing academic record and was elected to 
Alpha Omega Alpha. He served his intern- 
ship at the Hospital of the University of 
Pennsylvania for two years. Thereafter, as 
recipient of the Agnew Fellowship in Sur- 
gery, he completed his surgical residency 
training in 1928 as the first resident in a 
formal training program at the University 
of Pennsylvania. 

He then spent one year in Germany at 
the University of Frankfurt and in 1929 
returned to Philadelphia. He was appointed 
Instructor in Surgery at the University of 
Pennsylvania and Chief of the Surgical 
Outpatient Clinic at the University Hospi- 
tal. In 1938 he was promoted to Assistant 
Professor and also began to serve as one of 
the Chiefs of Surgery at the Philadelphia 
General Hospital. 

In 1942 he entered the Naval Medical 
Corps and went with the University of 
Pennsylvania Naval Medical Unit, orga- 
nized in 1935 by Dr. Richard A. Kern, to 
relieve the regular naval medical staff on 
the USS Solace. The Solace, a superbly 
equipped new hospital ship, was then going 



259 



260 



PAUL NEMIR, JR. 



into service in the Pacific Theatre. As the 
Chief of Surgery, he helped compile a rec- 
ord low mortality rate from battle casu- 
alties. Of 4,039 patients treated on the ship, 
only 12 died. 

Upon his return to the United States, he 
was appointed Chief of Surgery at the 
United States Naval Hospital at St. Albans, 
New York. He was discharged in October, 
1945, with the rank of Captain. 

He returned to Philadelphia and was 
appointed Clinical Professor of Surgery at 
the University of Pennsylvania. The fol- 
lowing year he was appointed Professor of 
Surgery in the Graduate School of Medi- 
cine. Also, in 1946, he was appointed Pro- 
fessor and Chairman of the Department of 
Surgery at the Woman's Medical College of 
Pennsylvania, a position which he held 
until 1959. In 1959, he succeeded Dr. Her- 
bert Reid Hawthorne as Chairman of the 
Department of Surgery in the Graduate 
School of Medicine and Chief of Surgery at 
the Graduate Hospital. He served in this 
capacity until his retirement in 1962. 

These are the facts. They tell a lot. There 
is more, however, of a lasting nature, which 
should be told. What were those qualities 
in Kraeer Ferguson that allowed him to 
attain such eminence and which were im- 
pressed on the young people whom he 
taught and trained. The attributes are not 
difficult to pinpoint in this instance. They 
were an excellent intellect, hard work in 
his chosen endeavor and complete dedica- 
tion to it, and an absolutely thorough and 
meticulous approach to every activity in 
which he was engaged. 

There were many stages in his life where 
these attributes were clearly demonstrated. 
Some were early shown and early recog- 
nized. In the correspondence of 1919 be- 
tween Huber Ferguson and the Pennsyl- 
vania School of Medicine, the father wrote 
of the work which his son was doing in 
Europe during the time of his enlistment 
and immediately after the Armistice. A short 
paragraph from one of these letters is re- 



vealing: "In addition to the work which the 
registrar has certified, I can testify that he 
has been in attendance at the University of 
Marseilles from March 14 to June 14, and 
has devoted his time to chemistry (lectures 
and laboratory work) and to French. Of 
course, I know nothing of the kind of work 
he did, but I would expect it to be 
thorough." It was characteristic that Kraeer 
would utilize his time to the fullest advan- 
tage on cessation of hostilities. 

During the summer of his second year in 
medical school, he applied for a position as 
an extern at the Connecticut State Hos- 
pital in Middletown, Connecticut. A letter 
from the dean to the superintendent of that 
institution stated as follows: "I take great 
pleasure in recommending him for your 
kindly consideration. Mr. Ferguson is an 
exceptionally good student, one of the best 
men in his class, and is everything that 
could be desired, and I feel that you will be 
very well pleased with him, should you give 
him the appointment which he seeks." 

These same attributes were again demon- 
strated during the one year he spent in 
Germany at the University of Frankfurt, 
and it was on the basis of that experience 
that he translated the two-volume book, 
Operative Gynecology, by Dr. H. B. Pehan 
and Dr. J. Amreich into English. 

These same attributes were demonstrated 
during the time that he was the Chief of 
the Outpatient Clinic when, in addition to 
a multitude of other duties, he began the 
work on two books. One of these, The Sur- 
gery of the Ambulatory Patient, was pub- 
lished in 1942 and has gone through a num- 
ber of revisions. It is a standard reference 
work in the field. The other, Surgical 
Nursing, is now in the 11th edition. The 
earlier editions were published with Dr. 
Eldridge Eliason, with whom Dr. Ferguson 
received much of his early surgical training. 

They were demonstrated so well during 
the outstanding record on the USS Solace. 
A colleague, writing about this experience 
in later years, stated: "Even Fergy could not 



MEMOIR OF LEWIS KRAEER FERGUSON 



'21,1 



complain about not having enough sur- 
gery to do." 

And, finally, they were demonstrated re- 
peatedly in his teaching and demonstra- 
tions to students and house oflicers. He was 
precise and meticulous in his dissections 
and had that rare quality of being able to 
expound succinctly even when operating 
under the most stressful circumstances. 

Several months prior to his retirement, 
Dr. Ferguson was suddenly incapacitated 
with a cerebral vascular accident. While 
there was gradual recovery, he never re- 
gained full use of his left hand and he, 
therefore, retired from active practice. 

Despite this severe handicap, he did, how- 
ever, continue to be active in teaching and 
in his writing. It was during this period that 
he spent the major portion of his time on 
the third book, soon to be published, en- 
titled, Explain It to Me, Doctor. He had 
long felt that doctors did not spend enough 
time explaining an illness to a patient, or 
what surgery was being done, or what was 
to be accomplished by surgery, and he 
hoped that this book would help fill the 
need. 

In addition to his books, Dr. Ferguson 
was also author or co-author of more than 
150 articles published in medical journals. 
These were based on observations from his 
wide clinical experience and dealt with a 
diversity of topics, among them, carcinoma 
of the stomach, gastrointestinal hemor- 
rhage, gastric resection, regional enteritis 
and ulcerative colitis. 

Dr. Ferguson was a member of many 
medical organizations, including the Ameri- 
can Medical Association, Philadelphia 
Academy of Surgery, American Gastroen- 



terological Association, American College 
of Surgeons, American Surgical Association, 
Bockus International Society for Gastroen- 
terology, American Society for Experimen- 
tal Pathology, Sigma XI, Federated Ameri- 
can Society for Experimental Biology, Pan 
Pacific Surgical Association, International 
Surgical Group, Soci^td Internationale de 
Chirurgie, Sydenham Coterie, and the Sur- 
geons Club. He served as an officer in a 
number of these organizations. 

He was named Honorary Professor at 
the University of Santo Domingo in the 
Dominican Republic. In 1960, he received 
the Alumni Achievement Award from his 
alma mater, Westminster College, for dis- 
tinguished accomplishment. In his honor, 
Woman's Medical College of Pennsylvania 
has established the L. K. Ferguson Visiting 
Professorship to bring guest professors to 
the college. 

Because of his ability and interest in 
medical writing, the University of Pennsyl- 
vania School of Medicine is establishing a 
Memorial Prize for young physicians to 
attain greater competence in medical writ- 
ing. 

Surviving are his wife, the former Ruth 
Griswold; three daughters, Mrs. T. Leonard 
Shephard, Mrs. Karl Meyers and Mrs. 
Gerald McConomy; two step-daughters, 
Mrs. Richard G. Ulrich and Ann Hender- 
son; three brothers, Robert G., Paul and 
Dr. James; three sisters, Mrs. William 
Hoover, Mrs. William Thomas and Mrs. 
Helen Eckerson, and nine grandchildren. 

Dr. Ferguson will be missed, but through 
his Visiting Professorship, Memorial Prize, 
his books and, most especially, his trainees, 
he will be long remembered. 



Memoir of Harrison Fitzgerald Flippin 

1906-1968* 

By CHARLES A. W. UHLE, M.D. 



HARRISON Fitzgerald Flippin lived 
a life of extraordinary dimensions. 
His is the story of excellent per- 
formance and outstanding achievement. A 
native Virginian, he spent his early youth 
and student years in the Cavalier country. 
In the latter half of his life, Philadelphia 
and Douglassville, Pennsylvania, claimed 
him as their distinguished citizen. 

He was born in Charlottesville, Virginia, 
on October 26, 1906. Of fine patrician stock, 
and, with an upbringing of the highest 
spiritual quality, his character and bearing 
were moulded in early life to make him a 
leader amongst men. He possessed a keen 
intellect. He was original and independent 
in thought. His industrious application to 
whatever the project yielded tremendous 
results. His warm personality and genial 
smile, combined with a keen sense of 
humor, won him many friends. With the 
numerous honors that were bestowed upon 
him, he remained a simple, God-fearing 
man whose heart knew compassion and 
humility. The fine coordination between 
body and mind carried him to the pinnacle 
of athletic prowess. The accolade of the 
University of Virginia's finest athlete ever 
to graduate from this venerable institution 
is still to be challenged. His father, Dr. 
James Carroll Flippin, an internist and 
Dean of the University of Virginia's Medi- 
cal School, undoubtedly was a potent stimu- 
lant to his son's embracing the study of 
medicine. 

Harry, and/or Flip, as he was known to 
his family and many friends, attended the 
Episcopal High School in Alexandria, Vir- 

* Prepared and published at the request of the 
Council of The College of Physicians of Philadel- 
phia. 



ginia. Here he developed into a superior 
student and stellar athlete. He was profi- 
cient in a multiplicity of sports and left an 
enviable record in track when he was gra- 
duated in 1926. Flip remained a loyal 
alumnus and always maintained a great 
interest in his many friends amongst the 
faculty and student body. Later in life came 
election to the Board of Trustees and mem- 
bership on various important policy-making 
committees. The crowning glory of his 
student days was the recognition of his past 
triumphs in the dedication on May 13, 1967, 
of the Harrison Fitzgerald Flippin Field 
House on the Alexandria campus, a gift of 
his numerous friends and patients. 

He was graduated from the University of 
Virginia in 1929, establishing an enviable 
record in scholastics and sports. A few of 
the honors bestowed were election to Phi 
Beta Kappa, the presidency of his senior 
class, and membership in O.D.K., the na- 
tional leadership fraternity. 

He had played first base on the Episcopal 
High School team and was offered in 1926 
a contract in pro baseball by the late Clark 
Griffith, owner of the Washington Senators. 
This was not accepted because of his ambi- 
tion to become a doctor. In college the pur- 
suit of his premedical studies came first, his 
spare time being allotted to making records 
in track and football. The year 1927 
claimed him as National Pentathlon Cham- 
pion, a grueling test: the 220 yard dash, the 
mile, the broad jump, discus and javelin. In 
1929 he held the world indoor record for 
the 60 yard high hurdles and tied the mark 
for the 50 yard low hurdles. Flip was never 
defeated in closed competition, either at the 
High School or the University. In the 
spring of 1929, he outdistanced a notable 



262 



MEMOIR OF HARRISON FITZGERALD FLIPPIN 



263 



group of competitors to win the 120 yard 
high hurdles event in the Penn Relays at 
Franklin Field. In 1927 he was a member 
of the All-American Track Team, and in 
1928 he was named End on the All 
Southern Conference Football Team. 

Harry was graduated from the University 
of Virginia Medical School in 1933 and was 
president of its senior class. Following the 
scholarship as well as the athletic tradition, 
he was elected to A.O.A. 

Alter serving his internship at the Hospi- 
tal of the University of Pennsylvania, he be- 
came its Resident, then its Chief Medical 
Resident, and finally the Edward Bok Fel- 
low in Medicine. 

From 1937 to 1965, he practiced internal 
medicine in Philadelphia, finding time dur- 
ing these years to produce 242 publications 
and 2 books, Medical State Board Questions 
and Answers and Antimicrobial Therapy. 
He held the rank of Clinical Professor of 
Medicine at the University of Pennsylvania. 
He was a popular teacher and much in 
demand as a speaker. 

For many years he was Visiting Physician 
to the Philadelphia General Hospital and 
at the time of his death held the rank of 
Active Honorary Consultant. In 1951 he 
was appointed as an Associate to the Medi- 
cal Staff of the Lankenau Hospital. His 
pioneer work in chemotherapy brought him 
world renown. His clinical and research 
work in the field of bacteriology and micro- 
bial therapy led to the modern concept of 
infectious disease treatment and manage- 
ment. He was among the first to show that 
the sulphonamides could reduce the mor- 
tality of pneumonia by fifty percent. 

Harry was a Diplomate of the American 
Board of Internal Medicine and a Fellow of 
the American College of Physicians; he 
belonged to a legion of medical societies. 
Many academic honors were accorded him. 
At one time or another he served on the 
boards of numerous medical and non-medi- 
cal institutions. 

During World War II, his war effort was 



directed to the Office of Scientific Research 
and Development. Also in the later years 
of his life he was appointed a member of 
the Board of Health of the City of Phila- 
delphia. 

He was a staunch Episcopalian and a 
member of the vestry of his neighborhood 
church. 

In 1937, Harry was married to Edith 
Quier of Reading, Pennsylvania, one of 
America's outstanding women golfers, and 
amusingly enough one whom he was never 
able to defeat on the links in any type of 
competition. To this union were born three 
children, James Carroll, William Seyfert 
and Lucy Lee. He loved his family deeply 
and often spoke of them. Their talents and 
many accomplishments were a source of 
pride to him. 

One of his closest friends, W. Thornton 
("Pete") Martin has reported the following 
quotation from a conversation with Harry: 
"During every man's life, many things 
happen to him which he owes to other 
people, to other institutions. In my own 
life, I owe more to the Episcopal High 
School than I can ever possibly repay. I not 
only got an academic training there; I was 
also able to take part in athletics. The com- 
petitive instinct I absorbed there helped me 
all through life. In later years, when I was 
running for my patients, as a physician 
against the Grim Reaper with the bony 
fingers and scythe, I'm glad to say I some- 
times came in first." 

During his long and tragic illness, he dis- 
played the tremendous faith, the fortitude, 
the stoicism, the personal heroism which 
placed him above the common herd. This 
same Grim Reaper, of whom he had so 
often spoken, took His toll on November 
21, 1968. 

Harry loved life and cherished the bonds 
of friendship of the many people he knew. 
His was the faculty of treating the serious 
in a light vein and of making his friends 
laugh with his wit and facetious remarks. 
As the final curtain was coming down, 



264 



CHARLES A. W. UHLE 



Harry referred to his impending burial in 
old St. Gabriel's Churchyard in Douglass- 
ville as going to join his old friends, the 
Indians and Revolutionary War heroes who 
had been buried in its historic and hal- 
lowed ground. 

Knowing him well, and keenly apprecia- 
tive of his friendship through these many 



years, sharing in a professional relationship 
that was never marred by an argument or 
dispute, and having the privilege to ad- 
minister to him in his illness, I can say 
without equivocation, "Here was a man, 
a man of extraordinary stature. He was as 
great a physician as he was an athlete." 



^ - 



Memoir of Abraham Mapow 
1907— 1969* 

By FREDERICK HARBERT, M.D. 



ABRAHAM Mapow, M.D., Instructor 
/-\ in Otolaryngology at the Jefferson 
Medical College of Philadelphia, 
died suddenly on May 4, 1969. 

He was graduated from Temple Univer- 
sity with a B.A. degree in 1929 and an M.D. 
degree in 1933. He interned at the Albert 
Einstein Hospital in 1933-4. He attended 
the Graduate School of the University of 
Pennsylvania in Otolaryngology in 1940 
and was certified by the American Board of 
Otolaryngology in 1949. 

He was a member of the Philadelphia 
Laryngological Society, The College of 
Physicians of Philadelphia and the Ameri- 
can Academy of Ophthalmology and Oto- 
laryngology. 

For twenty years he taught in the Gra- 
duate School of the University of Penn- 
sylvania and Philadelphia General Hospi- 

• Prepared and published at the request of the 
Council of The College of Physicians of Philadel- 
phia. 



tal, volunteering many hours per week in 
these activities. In the last ten years, he was 
equally faithful in teaching medical stu- 
dents and residents at the Thomas Jefferson 
University Hospital and the Jefferson Medi- 
cal College affiliated hospitals, Philadelphia 
General Hospital and the Veterans Admin- 
istration Hospital at Wilmington. 

In addition to his private practice, he 
gave extensive service to the Police and 
Fire Departments of Philadelphia and 
served on the staffs of Roxborough Memo- 
rial Hospital and Oxford Hospital. He was 
a devoted member of the B'nai Abraham 
Synagogue. His hobbies included a collec- 
tion of classical records. 

To his friends and colleagues, he will be 
remembered as a family man, completely 
devoted to his wife, Claire, and children, 
Sherry, Mark and Larry. His youngest child, 
Larry, is a Ursinus College junior and pre- 
medical student. To have his son follow his 
profession would be Abe's greatest pleasure. 



265 



Memoir of Ford A. Miller 
1895-1968* 

By JOHN D. CORBIT, JR., M.D. 



FORD A. Miller, M.D. was born in 
Easton, Pennsylvania, on January 3, 
1895, and was graduated from La- 
fayette College in 1917. He was a member 
of Phi Beta Kappa and received his medical 
degree from the University of Pennsylvania 
in 1921. Starting as intern from 1921-3, 
Dr. Miller was to devote all of his life to the 
Pirsln tcrian Hospital. As Chiel Resident 
during 1923 and 1924, he began his active 
interest in the Alumni Association for 
which he provided support and leadership 
until his death. 

Dr. Miller was licensed in the Common- 
wealth of Pennsylvania in 1923. He became 
an Instructor in the Graduate School of 
Medicine of the University of Pennsylvania 
in 1924 and continued teaching there until 
he resigned as Assistant Professor of Obstet- 
rics and Gynecology in 1910. During these 
years, he was active on the staffs of botli 
Presbyterian and Graduate Hospitals. 

* Prepared and published at the request of the 
Council of The College of Physicians of Philadel- 
phia. 



Having been certified by the American 
Board of Obstetrics and Gynecology in 1935, 
he became Chief in the Department of Ob- 
stetrics and Gynecology at the Presbyterian 
Hospital in 1939 and continued in this re- 
sponsibility until 1960. Dr. Miller, at vari- 
ous times, had been on the staffs of the Gra- 
duate, Philadelphia Lying-in, Woman's and 
Methodist Hospitals. From 1940 to 1960, he 
devoted his full time and energy to im- 
proving the service at Presbyterian. 

He was an active participant in the affairs 
of the Philadelphia County Medical Society 
and the Philadelphia Obstetrical Society. 
He was elected to The College of Physicians 
of Philadelphia on October 2, 1935. Dr. 
Miller was much too devoted to his patients 
to be able to enjoy fully his membership in 
the Philadelphia Country Club, the Union 
League and the Masons. 

At the age of 73 and after 47 years of 
practice, Dr. Miller died in the Presbyterian 
Hospital on December 5, 1968. Our com- 
munity has lost a dedicated clinician, a 
devoted teacher and a loyal friend. 



266 



Memoir of Gerald H. J. Pearson 
1893- 1969* 

By BERNARD J. ALPERS, M.D. 



DR. Gerald Hamilton Jeffery Pearson 
was born in Key West, Florida, on 
September 21, 1893, and died in 
Philadelphia on July 2, 1969. He was a 
graduate of the University of Western On- 
tario and of the University of Western 
Ontario Medical School. After eight years 
of general practice in Ottawa, Canada, he 
entered the Graduate School of Medicine 
in the University of Pennsylvania, where 
he was a Commonwealth Fellow in Neuro- 
psychiatry from 1925 to 1928, receiving the 
degree of Doctor of Science in Medicine 
(Sc. D., Med.). He entered the practice of 
child psychiatry in Philadelphia, which 
for the rest of his very productive life was 
the source of his professional activities. He 
became associated with Temple Univer- 
sity, where he served as Associate Professor 
of Child Psychiatry from 1940 to 1948. 
For many years he was Dean and Director 
of child analytical training of the Institute 
of the Philadelphia Association for Psycho- 
analysis, where he exerted a wide influence 
as teacher and as preceptor. He retired as 
Dean in 1959 at age 65. He was Professor 
of Psychiatry at Hahnemann Medical 
College and from 1962 to the time of his 
death he served as Professor Emeritus. 

He was a prolific and influential writer, 
and he was the author of many volumes 
and articles in the field of child analysis. 
His books included Emotional Disorders 
of Children, Adolescence and the Conflict 
of Generations, and Psychoanalysis in the 
Education of Children. He edited A Hand- 
book of Child Psychoanalysis, and he was 
co-author of Emotional Problems of Living 

* Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



and Common Neuroses of Children and 
Adults. 

He was a member of the American Psy- 
choanalytical Society, the American Ortho- 
psychiatric Society, the American Group 
Therapy Association, the American Society 
of Psychosomatic Medicine, the American 
Medical Association, the Philadelphia 
Pediatric Society, the Philadelphia Psychi- 
atric Association and the Philadelphia 
Neurological Society. 

During World War I, he was a Captain 
in the Canadian Army, and in World War 
II he served as consultant for the U. S. 
Women's Army Corps. 

He is survived by his wife, the former 
Mary Agnes McKenzie; two daughters, 
Mrs. Francis P. Bucher and Mrs. Lesley 
A. Fridenberg; a son, Lieutenant Com- 
mander (USN) George R.; and by a sister 
and four grandchildren. 

Child psychiatry is now a respected and 
accepted branch of general psychiatry. 
Hence it is difficult to realize how great 
were Dr. Pearson's contributions and how 
important was his influence in a day when 
not only was child psychiatry not recog- 
nized as a specialty, but in which psycho- 
analysis was looked upon almost with 
derision. During his years as a Common- 
wealth Fellow, he fought vigorously for 
the privilege of tailoring his studies to 
suit his needs and thus established a prin- 
ciple of graduate study from which those 
who followed him derived great benefit. 
His struggle developed out of a training 
environment which was strongly oriented 
toward an organic philosophy, and while 
he accepted this feature of his education 
he established also his right to pursue his 
psychiatric interests, a not inconsiderable 



267 



268 



BERNARD J. ALPERS 



feat in a department which was heavily 
weighted in favor of organic neurology. 
His training and his background in gen- 
eral practice, as well as his intellectual 
perspective, led him to recognize the im- 
portance of structure in emotional prob- 
lems. To the practicing physician this is 
now an accepted concept, but for an ana- 
lyst this was a revolutionary approach, and 
he was one of the pioneers of the psycho- 
somatic concept of psychiatric disorders. 
He remained conscious of both physical 
and emotional factors throughout his 
career. 

After the completion of his graduate 
studies, he became convinced that the 
symbolizations of child thinking and play 
could be understood best against a back- 
ground of psychoanalysis. After arranging 
for his own analysis, he came to apply 
analytical methods to the treatment of 
problems of abnormal behavior of chil- 
dren. The courage which this entailed 
must be understood against the back- 
ground of Philadelphia psychiatry at the 
time in which his decision was made. Not 
only was psychiatry still in the Kraepelin- 
ian stage; it was also openly antagonistic 
to Freud in particular and to psychoanaly- 
sis in general. His convictions brought 
him into conflict with the treatment 
philosophy of the Philadelphia Child 
Guidance Clinic of which he was then a 
staff member. Because the two opposing 
concepts could not be reconciled, he left 
the clinic in order to establish one of his 
own in Temple University. Here and in 
other departments where he worked later 
he established his school of child psychia- 
try where he trained many men who have 
continued his tradition. His viewpoint is 
reflected in his books, which he wrote for 
the general public and for those in medi- 
cine who were not psychoanalysts. His 
book on Adolescence was a clear descrip- 
tion of the problems of the growing man 
and woman, and anticipated by several 



years the present concern about the gen- 
eration gap. The Handbook of Child 
Psychoanalysis was the first authoritative 
book of its kind, the product of his own 
school of thought. 

He was a remarkably refreshing psychia- 
trist, who could be best characterized as a 
sensible psychoanalyst. He was never car- 
ried away by slogans. Permissiveness and 
discipline were not contradictory, particu- 
larly self-discipline. His training program 
in child analysis had as its basis a thorough 
understanding of child development, both 
physically and emotionally. It was one of 
the major principles of his teaching that 
this development was constantly changing 
from childhood to adolescence and that 
treatment methods needed adjustment to 
the demands of growth and change. He 
was no slave to a technique, despite the 
fact that his life work was done in a branch 
of medicine where this becomes easily 
possible. He was well aware of the short- 
comings of analysis and of determinism 
as a philosophy; hence, his opinions were 
well considered and remarkably broad in 
their perspective. He was never one to 
stretch facts or inferences, and behind all 
his analytical learning was a soft heart and 
great common sense. Though he was an 
orthodox Freudian, he lacked the rigidity 
of concept of many members of that 
group, and he was even acquainted with 
and interested in the organic neurological 
problems of children. Some of his early 
work had to do with the problem of 
aphasia and the development of speech in 
children. Their speech disorders con- 
tinued to interest him throughout his pro- 
fessional life. 

He was a kind, gentle and understand- 
ing man, and it was these basic qualities 
which endeared him to his friends and 
made him such a great psychiatrist. His 
interests apart from medicine were broad. 
He was raised in an environment which 
provided him with a firm love of the Bible. 



MEMOIR OF GERALD H. J. PEARSON 



269 



He loved poetry and was fond of quoting 
it. His friends remember him for his 
wisdom and tolerance and for his consid- 
erate patience. Like Lord Acton, he was 
able to judge character at its worst without 
loss of faith in his fellow-man. There were 



many among family, friends and patients 
who looked to him for help. All who were 
so fortunate as to be touched by his gentle 
spirit were enriched and ennobled by the 
experience. 



Memoir of Stanley P. Reimann 
1891^1968* 

By TIMOTHY R. TALBOT, JR., M.D. 



STANLEY P. Reimann was a man of 
great energy, gifted imagination, 
quickness of mind, persistence of pur- 
pose, and much courage and conviction. 
There is no doubt that he made a great 
contribution to biological and medical re- 
search and that he was one of the major 
forces in bringing the word "cancer" out 
of the darkness of fear and secrecy into the 
light of scrutiny and study. He had a 
bright personality and always left a vivid 
impression on everyone he met. 

I never knew Stanley Reimann until 
after I had become his successor as Direc- 
tor of The Institute for Cancer Research, 
but in the succeeding decade I had the op- 
portunity to know him and to learn at 
first hand much of the history of the pre- 
ceding 32 years in which he was so deeply 
involved. I have had the additional advan- 
tage of knowing many of the people with 
whom he worked for many years and of 
seeing the true nature of his philosphy as 
it was expressed functionally through the 
Institute. Stanley Reimann had no desire 
whatever to retire when he did, so that his 
friendly acceptance of me led to a unique 
relationship and lent expression to his 
largeness of spirit. 

Numerous obituaries have already been 
published to chronicle his formal accom- 
plishments, awards and honors. These may 
be summarized as follows: 

Stanley Reimann was educated in his 
native Philadelphia at Central High 
School and at the University of Pennsyl- 
vania, from which he received the degree 
of Doctor of Medicine in 1913. He in- 

* Read before The College of Physicians of Phila- 
delphia, 14 May 1969. Prepared and published at 
the request of the Council of The College of Physi- 
cians of Philadelphia. 



terned at The Lankenau Hospital in 
Philadelphia, was a resident pathologist at 
the Lakeside Hospital in Cleveland, and 
was a Hanna Fellow in Experimental 
Pathology at Western Reserve University. 
Upon his return to Philadelphia, he was 
named pathologist at The Lankenau 
Hospital and soon became concerned 
about the cancer problem. 

The vision and ability of Dr. Reimann 
to transmit his enthusiasm to others were 
responsible for his most important con- 
tribution to science and medicine, namely, 
the founding in 1925 of The Lankenau 
Hospital Research Institute for the study 
of normal growth as well as cancer. His 
first partner in the scientific aspects of this 
project was Dr. Frederick S. Hammett, a 
physiologic chemist. Both men viewed the 
study of cancer as a fundamental problem 
of growth and differentiation and felt 
that a successful attack required the team 
work of biologists and chemists. 

By the second decade of its existence, 
the Institute had attained world-wide 
recognition due to the foresight and 
energy of the Reimann-Hammett team. 
Growth of the research organization con- 
tinued steadily, and in 1945 The Institute 
for Cancer Research was formed with Dr. 
Reimann as Scientific Director. A few 
years later the research staff moved into 
greatly expanded quarters at the present 
Fox Chase location. Again the principle of 
conducting basic research in biology, 
chemistry and physics and the conviction 
that an understanding of the processes of 
growth and development would ultimately 
provide necessary knowledge for the con- 
quest of cancer were uppermost in Dr. 
Reimann's thinking and actions. 

Dr. Reimann was a member of the 



270 



MEMOIR OF STA 

Board of Directors of the American Asso- 
ciation for Cancer Research from 1950 to 
195:5 and was Vice President (1951-2) and 
President (1952-3). He also served the As- 
sociation capably as a member and often 
as Chairman of its Committees on Invest- 
ments, Finance, Program and Local Ar- 
rangements and was a regular attendant at 
the annual scientific meetings from 1931 
! to 1966. 

| Recognition from various sources came 
to Dr. Rcimann during his 32 years as 
Director and Scientific Director of the In- 

i stitute. He was appointed Professor of 

! Surgical Pathology in the Graduate School 
of Medicine at the University of Penn- 

i sylvania, Professor of Oncology at Hahne- 

' mann Medical College, Chief of Clinical 
Oncology at The Lankenau Hospital, and 
consulting pathologist at the Jeanes and 
The American Oncologic Hospitals. In 

i 1937 he received the Ward-Burdick Medal 
from the American Society of Clinical 

; Pathologists in recognition of his contri- 

, butions to the basic sciences, and in 1957 
the Strittmatter Award of the Philadelphia 

, County Medical Society was bestowed 
upon him for his contribution to the art 

, and science of medicine. Honorary doctor- 
ate degrees were conferred upon him by 
the Hahnemann Medical College (1945) 

: and the Philadelphia College of Pharmacy 

1 and Science (1950). Dr. Reimann held a 
variety of important positions with the 

. American Medical Association, the Phila- 
delphia County and the Pennsylvania 
State Medical Societies, the American and 
Philadelphia College of Physicians, the 

i American Society of Clinical Pathologists 
(President 1946-7), and other national so- 
cieties concerned with various aspects of 
pathology. From 1948 to 1960, he served 
on the Council on Scientific Assembly of 

! the American Medical Association (Chair- 
man 1958-60) and played a major role 
in the organization of the general scientific 
programs for the semiannual meetings of 
this society. Dr. Reimann was active in 
several social organizations, such as the 



LEY P. REIMANN 271 

Union League of Philadelphia and the 
Pocono Lake Preserve, in addition to his 
work with various musical organizations. 

In 1957, having reached the age of re- 
tirement, Dr. Rcimann was appointed Di- 
rector Emeritus of The Institute for Can- 
cer Research. He immediately accepted a 
Fulbright lectureship and went to India to 
deliver a series of lectures and to partici- 
pate in tumor clinics of the type that he 
had introduced many years earlier at The 
Lankenau Hospital. In 1963, in collabora- 
tion with Dr. Grace Medes, he wrote a 
book entitled Normal Growth and Cancer 
to add to his previous output of more than 
100 medical and scientific papers on car- 
cinogenesis, wound healing, chemother- 
apy, cancer control, and care of the cancer 
patient. 

He is survived by his wife, Elsie Bein 
Reimann, two daughters, Mrs. George 
Nehrbas and Mrs. John W. Bodine, and 
six grandchildren. 

A portait of Dr. Reimann was com- 
pleted and unveiled two months before 
his death; it hangs in the lobby of the In- 
stitute he founded and will remind the 
staff and visitors of the dedication of this 
pioneering and inspiring leader of the Re- 
search Institute from 1925 to 1957. 

The calendar of events that marked his 
education, training, honors and activities 
attest to the recognized quality of his 
scholarship and abilities. To those who 
knew him, however, it is the man himself 
who needs to be recalled and retained in 
memory as a standard. 

At a time when the nation was in the 
throes of economic depression, he man- 
aged to keep alive an ideal and a vision 
which later flourished and grew into sta- 
ble and lasting form. His concept that 
biological and biochemical research were 
the necessary basis for an understanding 
of cancer was quite new when he was in- 
strumental in founding The Lankenau 
Hospital Research Institute in 1925. This 
Institute later became The Institute for 



272 



TIMOTHY R. TALBOT, JR. 



Cancer Research in Fox Chase, Philadel- 
phia. 

Stanley Reimann had great charm — he 
liked people and always had a bright and 
cheerful contribution to give to those 
whom he encountered. He was a kindly 
physician and never lost his contact with 
patients. He liked children and they liked 
him. He liked to go trout fishing and loved 
the woods and all of nature. He remained 
a skilled musician until the end of his life 
and played the piano and organ with 
genuine gusto. He loved to exercise his 
fluent knowledge of the German language 
and could do so at just the right moment 
in just the right way — usually at the ex- 
pense of the unwary. 

He was a man deeply involved with all 
of life and culture, and he moved through 



life with unbroken adherence to the exu- 
berant exercise of his talents and convic- 
tions. He influenced hundreds of people — 
probably thousands — and almost single 
handedly created a new institution. He left 
his mark on the world and helped to im- 
prove it in all of the diverse areas where 
he worked and lived. Medical education, 
medical research and cancer research were 
all perceived in a perspective by Stanley 
Reimann in a way that led to their ad- 
vancement and in a way that remains valid 
today. He was in some ways ahead of his 
time, and in other ways, not of his time. 

Let us hope that other men will appear 
who are cast from a similar mold, and be 
grateful that his talents were directed to- 
ward such high purposes. 



Memoir of Helena E. Riggs 
1899-1968* 

By RUSSELL S. BOLES, M.D. 



D 



R. HELENA E. Riggs was born in 
Philadelphia on December 18, 1899. 
She was educated in private schools 
and then at Bryn Mawr College in 1917. 
After two years at Bryn Mawr, she trans- 
ferred to the University of Pennsylvania, 
from which she was granted a Bachelor of 
Arts degree in 1921. 

She then attended the School of Medi- 
cine of the University of Pennsylvania 
from which she received her M.D. in 1925. 
Following this, she served as an intern at 
the Philadelphia General Hospital, a 
privilege which was rarely accorded 
women in those days. She followed her in- 
ternship with a year of graduate study in 
Pathology at the University of Pennsyl- 
vania. From 1928 to 1932, she was asso- 
ciated with Dr. William McConnell in 
the clinical practice of neurology. Dr. 
Riggs had always been keenly interested in 
neuropathology, and, following the death 
of Dr. McConnell, she became associated 
with Dr. Nathaniel Winkleman, who at 
that time was part-time neuropathologist 
at the Philadelphia General Hospital. 

It was only natural because of her ex- 
raordinary talent that she should become 
full-time Chief of the Neuropathology 
Laboratory at the Philadelphia General 
Hospital in 1935, a position which she 
held continuously until her death on 
October 7, 1968. It is appropriate to record 
here that the Laboratory of Neuropathol- 
ogy at the Philadelphia General Hospital 
was the first such laboratory to be estab- 
lished in this country. In 1948, Dr. Riggs 
and Dr. Webb Haymaker were the first 

• Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



two neuropathologists to receive certifica- 
tion in Neuropathology by the American 
Board of Pathology. 

During the second World War, Dr. 
Riggs served as a consultant for the U. S. 
Navy and was included in a team of spe- 
cialists who had the responsibility of de- 
veloping neurologists in a six-week period. 

Dr. Riggs was President of the Phila- 
delphia Neurological Society in 1950, an 
honor that previously had never been ac- 
corded a woman in the history of that or- 
ganization. She was appointed Assistant 
Professor of Neuropathology at the Univer- 
sity of Pennsylvania in 1950 and in 1960 
was advanced to full professorship in her 
specialty. 

Dr. Riggs was a member of the following 
scientific societies: American Association 
for Research in Nervous and Mental Dis- 
eases, American Neurologic Association, 
American Academy of Neurology, Ameri- 
can Association of Neuropathologists, 
American Association for the Advance- 
ment of Science, Society of Biological Psy- 
chiatry, The College of Physicians of Phila- 
delphia, Philadelphia Neurological Society. 
The American Association of Neuropa- 
thologists recently approved the placing of a 
plaque in the Neuropathology Laboratory 
of the Philadelphia General Hospital. The 
plaque was suitably inscribed as follows: 
"To the memory of Dr. Helena Riggs, 
in recognition of her services to American 
Neuropathology." 

Dr. Riggs was intensely devoted to her 
specialty which she greatly enriched by her 
many major contributions to its literature, 
especially in the field of cerebral-vascular 
disease. It was my good fortune to co-au- 
thor a number of papers with Dr. Riggs, 



273 



274 



RUSSELL S. BOLES 



chiefly on the neurogenic and circulatory 
factors in the etiology of peptic ulcer and 
on Wernicke's Disease. At the time of her 
death, Dr. Riggs was engaged in writing a 
book on myelinization of the infant brain. 
This book was the product of seven years' 
study on this subject in which she was as- 
sisted by Dr. Lucy Rorke, who joined her 
in 1961, as an NIH trainee. Dr. Rorke re- 
mained with her as her assistant until the 
time of her death. Ironically, Dr. Riggs' 
publishers, the J. B. Lippincott Co., de- 
cided to accept her manuscript for pub- 
lication just a few hours after Dr. Riggs 
had died. Fortunately, Dr. Rorke was able 
to complete the work so that it will be 
published in the very near future. Dr. 
Riggs was a scholar of high intellectual 
achievement and as a superb teacher de- 
voted much of her time to sharing her 
knowledge with her colleagues and the 
students who were fortunate enough to 
work with her. 

Her major avocational interests centered 
about her home with its extensive gardens. 
These were exquisitely nurtured and pro- 



vided a deep source of satisfaction and 
pleasure to her. She was also a gourmet 
cook, one of those rare seamstresses who 
never used a sewing machine even for 
making dresses, and a particularly accom- 
plished knitter and needle-worker. 

She had always enjoyed excellent health 
so that her sudden death from a massive 
coronary while on holiday with her family 
in California was especially shocking. 

On December 18, 1968, a memorial serv- 
ice was held in the Medical Library of the 
Philadelphia General Hospital in honor of 
Dr. Riggs. Dr. Charles Rupp, nationally 
prominent Philadelphia neurologist and 
long-time friend and associate, delivered 
a eulogy in her honor. One of her out- 
standing pupils, Dr. John McGrath, world- 
renowned neuropathologist, added a sec- 
ond tribute to the memory of this great 
lady. 

Dr. Riggs' passing creates a great loss in 
the field of neuropathology, and one can 
only hope that her many co-workers will 
maintain the high traditions for which she 
was so well admired. 



Memoir of Lennard L. Weber 
1915-1969* 

By S. LEON ISRAEL, M.D. 



1ENNARD L. Weber was a product of 
. Philadelphia. He was born here on 
May 18, 1915, received a Bachelor of 
Arts degree from the University of Pennsyl- 
vania in 1937, and was graduated from the 
Hahnemann Medical College in 1931. He 
married his childhood sweetheart, Rose 
Gussman, while a medical student. Follow- 
ing an internship at the Mount Sinai Hos- 
pital (now Daroff Division of the Albert 
Einstein Medical Center), he entered upon 
a 4-year stint of active military service. He 
served in the Medical Corps of the United 
States Army, supporting troops in many 
areas of the South Pacific, was decorated 
for gallantry, attained the rank of Major, 
and returned at the conclusion of World 
War II to be plagued for several years by 
recurring bouts of malaria. He entered 
the field of obstetrics and gynecology by 
being a resident for three years (1948-50) 
at the Mount Sinai Hospital. He began 
his practice in that specialty during the 
fall of 1950 and was certified by the Amer- 
ican Board of Obstetrics and Gynecology 
in 1952. Doctor Weber's growing practice 
did not interfere with his desire to con- 
tribute to medical education and to be an 
active member of obstetric and gyneco- 
logic organizations. His activities as a 
1 teacher were pre-eminent, initially in the 
I Graduate School of Medicine and later in 
the School of Medicine, University of 
Pennsylvania. Several weeks prior to his 
death he had been promoted to the rank of 
' Associate Professor of Obstetrics and 
j Gynecology at the University of Pennsyl- 
vania. His hospital duties, always executed 



• Prepared and published at the request of the 
Council of The College of Physicians of Phila- 
delphia. 



with an earnest sense of responsibility, in- 
volved him with the Graduate Hospital of 
the University of Pennsylvania, Pennsyl- 
vania Hospital and the Einstein Medical 
Center. He had positions of senior respon- 
sibility in each of them. 

Doctor Weber was known as a reliably 
dependable committee member in all of 
his organizational work. He was an active 
member of local and state medical socie- 
ties, the American Medical Association, 
the American College of Surgeons, The 
American College of Obstetricians and 
Gynecologists, The College of Physicians 
of Philadelphia, the American Association 
of University Professors, and the American 
Fertility Society. He was especially earnest 
in his efforts to assist in the early growth 
and development of the local District work 
of The American College of Obstetri- 
cians and Gynecologists, involving himself 
in all sorts of educational programs in 
Pennsylvania, Delaware, and New Jersey. 
He never failed to respond to a call for 
work in the Philadelphia Obstetrical 
Society in which he was, at the time of his 
death, the First Vice-President. One of his 
most distinctive contributions to the medi- 
cal scene of Philadelphia was his splendid 
chairmanship of the Maternal Welfare 
Committee of the County Medical Society 
for many years. Most of the senior obstetri- 
cians in Philadelphia will recall the prodi- 
gious effort he expended in the interest of 
that Committee. Doctor Weber was par- 
ticularly interested in the welfare of the 
pregnant woman and her product, an in- 
terest that probably stemmed from his 
many years of service to the Maternal 
Welfare Committee. During the last 10 
years of his life, he brought a particular 



275 



276 



S. LEON ISRAEL 



devotion to the study of fetology and en- 
gaged himself in several basic research ac- 
tivities in that most important subspe- 
cialty. In this spirit, it was most natural 
for him to be willing to assume (by relin- 
quishing some of his private practice) the 
duties of Medical Director of the Maternal 
and Infant Care Program at Pennsylvania 
Hospital, an activity that he not only en- 
joyed but carried off most effectively. 

Doctor Weber's enthusiasm for his 
chosen specialty never wavered. He was an 
earnestly involved figure at any meeting, 
identified readily by his impeccable order 
of dress, charming affability and handy 
cigar. Although prematurely terminated, 
Doctor Weber's life was filled with service 
to his profession in many ways and one 
which he enjoyed because of his variegated 
concerns. In addition, for many years he 
indulged his hobby in photography, dis- 
playing a widely admired artistic ability 
as well as matchless taste. He was capable 
of enthusiasm regarding works of art, 
theatre and modern literature. Despite all 
such varied interests, Doctor Weber re- 
mained a deeply religious person, one de- 
voted to the tenets and principles of his 



faith. It was, perhaps, the latter charac- 
teristic that sustained his dear ones and 
close friends during the hours he planned 
his immediate future, involving not only 
the coming marriage of his only daughter 
but also what he knew would be a long 
recovery period, as he faced the known 
ordeal of a radical operation for an esoph- 
ageal carcinoma on February 14, 1969. He 
succumbed to pneumonia during the sec- 
ond postoperative week. 

Doctor Weber is survived by his wife, 
Rose, of 30 years; a daughter, Nancy; and 
a son-in-law, Stephen Machinton, who is a 
medical student. They may draw solace, as 
do his many friends and patients, from 
Doctor Weber's faith in God as well as in 
people. Our much-loved friend, a paragon 
of many virtues, left us with our knowledge 
of his awareness that he had a glowing set of 
family relationships, that he had imparted 
countless lasting gems of knowledge to hun- 
dreds of students as well as residents, and 
that he had contributed to the welfare of 
thousands of women as well as to the health 
of their unborn children. He will rest in 
peace. 



A Letter from the Benjamin Rush House 

Committee 



II The Honorable Raymond P. Shafer 

Governor, Commonwealth of Pennsylvania 
I lie Honorable Hugh Scott 

U. S. Senate 
I he Honorable Richard S. Schweiker 

U. S. Senate 
I he Honorable James H. J. Tate 

Mayor, City of Philadelphia 
1 he Honorable Joshua Eilberg 

U. S. House of Representatives 
I he Honorable John F. Byrne 
I J Senate of Pennsylvania 

Hal B. Jennings. Jr., Brigadier General 

The Surgeon General, United States Army 
Mary Brooks 

Director-Designate, U. S. Mint 
Gerald I). Dorman, M.D. 

President, American Medical Association 
Raymond W. Waggoner, M.D. 

President, American Psychiatric Association 
Robert F. Gohcen 
President, Princeton University 

Sponsoring 

University of Pennsylvania 

Dickinson College 

Franklin and Marshall College 

Pennsylvania Hospital 

Rush Hospital 

Philadelphia State Hospital 
American Psychiatric Association 

I he Philadelphia Psychiatric Societv 
Pennsylvania Medical Society 
The Philadelphia County Medical Society 
The College of Physicians of Philadelphia 
Pennsylvania Historical and Museum Commission 
| Historical Society of Pennsylvania 

Philadelphia Societv for the Preservation of Land- 
marks 

Order of the Founders and Patriots of America 
Descendants of the Signers of the Declaration of 

Independence 
City Parks Association of Philadelphia 



ary Patrons 

Gaylord P. Harnwell 

President, University of Pennsylvania 
Hon. iid L. Rubendall 

President, Dickinson College 
Keith Spalding 

President. Franklin and Marshall College 
\l I o<l,| Cooke, Jr. 

Chairman, Board of Managers, Pennsyhania Hos- 
pital 

Francis C. Wood, M.D. 
President, The College of Physicians of Phila- 
delphia 
Carl Binger, M.D. 
Lister Hill 

K.n I Mcnningcr, M.D. 

Benjamin Rush 

Jonas Salk, M.D. 

Leon Sullivan 

Paul Dudley White, M.D. 

Dwight Wilbur, M.D. 

Organizations 

The Colonial Philadelphia Historical Society 
Germantown Historical Society 
Historical Society of Frankford 
Somerton Civic Association 

Holmcsburg-Torresdale Historical and Art Society 
Pennsylvania Prison Society 
The Federation of Jewish Agencies 
The American Legion (Philadelphia County Coun- 
cil) 

Benjamin Rush Middle School 

I lie Philadelphia Convention and Tourist Bureau 
General Society of Colonial Wars 
The Philadelphia Foundation 
Merck Sharp & Dohme 
The Hoffmann-La Roche Foundation 
Residents Association — The Institute of the Penn- 

s\ Ivania Hospital 
Mental Health Association of Southeastern Penn- 
sylvania 



ACxROUP of citizens in Philadelphia 
has recently organized the Benjamin 
Rush House Committee, which aims 
to reassemble and restore the birthplace of 
the famous patriot and Signer of the Dec- 



laration oi Independence. Many distin- 
guished Americans have offered to serve as 
Honorary Patrons. The Benjamin Rush 
House Committee invites you to contribute 
toward this effort. 



277 



"Who knows but it may be reserved for America to furnish the world from 
her productions, with cures for some of those diseases which now elude the 
power of medicine?" 

Medical Inquiries and Observations, 1789 




Benjamin Rush (1745-1813). Attributed to Benjamin West, this portrait hangs in The Col- 
lege of Physicians of Philadelphia. 



278 



Id N | \MI\ Kl SH HOI SI COMMITTEI LET! I K 



279 



I ci us acquaint yon more lnll\ with 
Benjamin Rush and with out project. 

Doctor Benjamin Rush, the Eoremosi 
physician ol the young American Repub- 
lic, was in .1 modest stone farmhouse 
in Byberry Township, now a section ol 
Northeast Philadelphia. After graduation 
from Princeton ,ii age II. In- obtained his 
medical diploma at the University ol Edin- 
burgh and began a lifetime ol medical 
pi ac ( ic e in Philadelphia. 

Rush's medical accomplishments alone 
merit him a permanent place among the 
giants of American medic inc. lie became 
the first Professor of Chemistry at the Na- 
tion's Inst medical school, the University 
of Pennsylvania, and wrote the first book 
on ehctnistiv in America, lie set ved as 
physician to Pennsylvania Hospital lot 
thirty years and became the hero ol the 
yellow fevet epidemics ol die I790's. Be- 
cause he published the hist book on men- 
tal illness in America (1812), he is known 
as the "Father of American Psychiatry," 
and his profile is in the seal of the Ameri- 
can Psychiatric Association. He is likewise 
hailed as "patron saint'' by obstetricians, 
pediatric i. ins. veterinarians and tubercu- 
losis specialists, as well as by those in 
military medicine. He was 1 1 i c - most es- 
teemed medical te.u hei of 1 St h Century 
America and the first American ph\sician 
to achieve an international reputation. 

Rush was one ol the original twelve 
founding Senior Fellows of The College of 
Physicians of Philadelphia, lie was a mem- 
ber of the Commit tee on Publication and 
assumed the task, with William Shippen, 
|r., and Samue l P. Giilhiis. ol preparing a 
preface for the first issue of the Transac- 
tions & Studies. 

Benjamin Rush was far more than a 
physician. Friend of Adams, Jefferson, 
Franklin and Washington, he stands 
among the greatest patriots of Revolu- 
tionary times. He was a member ol the 
Continental Congress in 177(i and a Signer 
ol the Declaration ol Independence. He 
gave the name Common Sense to Tom 



P. line's fiery pamphlet He became Physi- 
cian General in the Continental Aims. 
Washington relied on his advice prior to 
the Battles ol I teuton and Prince ton. In 
more peaceful time s. Rush became I reas- 
urer of the United Stales Mint. 

The significance of Rush foi us today, 
however, rests in his sociological contribu- 
tions. With Benjamin Franklin, Rush 
founded the first organization (1771) in 
America for the abolition ol slavery. He 
staunchly supported the Ereedom, educa 
tion and religious instruction of black 
Americans. He promoted public schools 
and was also a founder of Dickinson Col- 
lege as well as a founding trustee of 
Franklin and Mat shall Colle ge . He sup- 
ported the rehabilitation and reform ol 
criminals, as well as the abolition of cruel 
punishment and the- death penalty. He 
advocated establishments for the cure ol 
alcoholism. He promoted a dispensary lot 
the medical relief of the pool . 

In the light ol such ae c omplislinients, 
you cm well understand our wish to pre- 
serve Rush's birthplace as symbolic ol 
ideals and goals for which we strive today. 
The Rush House is the only birthplace ol 
a Signer ol the Declaialion ol I ndepend 
ence which we still have in Philadelphia, 
where the Declaration was written and 
proclaimed. The house was built in 1690 
by John Rush, great-grandfathei ol Ben- 
jamin, who fought under Cromwell and 
who arrived in Pennsylvania in 1683. The 
local neighborhood has gu n interest in its 
pi eset \ ation, as evidenced l>\ the number of 
local organizations serving as sponsors. 

Let me now acquaint you with our 
progress l<> date. Main citizens and organi- 
zations, local and national, have formed 
the' Benjamin Rush House Committee, 
which is now proceeding to incorporate. 
The stone and woodwork of the Rush 
House have been transferred from its oris:- 
i n.i I location (now a housing development) 
to the grounds of the Philadelphia State 
Hospital, where they can be carefully pro- 
tected until the reassembling can begin. 



280 



BENJAMIN RUSH HOUSE COMMITTEE LETTER 



The Commonwealth ol Pennsylvania has 
given permission foi reconstruction ol 1 1 1 c 
house on slate piopcm on a prominent 
sile alom; I S. Route 1, where it will he 
the lit. si hisioii( siiiHiure which the visitor 
to Philadelphia will see on entering our 
historic city by way of this busy highway. 
Philadelphia Slate Hospital has indicated 
that the house will Ire maintained in per- 
peluit) as one ol the hospital buildings. 
We hope that the linal result will resem- 
ble Washington's Headquarters at Valley 
Forge, a similar reconstruction project. 

We are now ready to launch a nation- 
wide fund-raising campaign for a goal of 
$150,000. A generous initial contribution 
of $5,000 has been made by the Philadel- 
phia Foundation and sizable grants have 
been received from Merck Sharp Sc Dohme 
and I hillniann-LaRoche Foundation. 



Tax-deductible donations may be made 
to The Historical Foundation ol Pennsyl- 
vania and mailed to Robert E. [ones, 
M.I). Ch airman, benjamin Rush House 
Committee, III \oilh 19th Slieet, Phila- 
delphia. Pennsylvania 19139. 

We hope you will support this worth- 
while endeavor. 
Sincerely yours, 

The Benjamin Rush House Committee 
Robert Frwin Jones, M.D. 

Chairman 
Daniel Blain, M.D. 

Vice Chairman 
Margaret M. Fluddleston 

Secretary 
Townscnd Munson 

Treasurer 
Harold Rosenthal 

Counsel 



To: The Benjamin Rush House Committee 

c/o Robert E. Jones, M.D. 

1 1 1 North 49th Street 

Philadelphia, Pennsylvania 19139 

My tax-deductible contribution of $ , payable 

to the Historical Foundation of Pennsylvania, is enclosed. 

Name 



Address. 



TRANSACTIONS 9f STUDIES 

of 

The College of Physicians of Philadelphia 



Volume 37 
(Fourth Series) 




Number 4 
(April 1970) 



The Philadelphia Neurosurgical Society 1 

By FREDI.RICK MURTAGH, Jr., m.d., f.a.c.s. 2 



I 



WELCOM1 this oppoi utility to speak 
about the Philadelphia Neurosurgical 
Society. Ii is rather startling, however, 
to discovei suddenly thai something with 
which one has been so iloseh associated 
has become ol historical significance. 

Physicians are the most gregarious peo- 
ple. They constantly need the association 
of other physicians for exchange ol ideas 
to feed theii intellectual appetites and as 
soil in which to seed the products ol then 
own fertile minds. The development of 
American medicine can be easily traced 
tin 'ough the archives ol an astounding 
number of medical organizations and 
societies thai have been formed and have 
existed since the first physician set foot in 
America. Every society is formed as a re- 
sponse for a need to communicate, and it 
will flourish so long as thai need exists. 
If the basic need becomes submerged in 
the academic and social progress of medi- 
cine, the organization may find a new pur- 
pose for its existence, merge with another 
society, or disband. In this manner, most 
organizations have survived in one form 

'Section on Medical History, The College of 
Physicians of Philadelphia, 18 November 1969. 

-Chairman of the Division of Neurological and 
Sensory Sciences and Professor of Neurosurgery, 
Temple University Health Sciences Center, Phila- 
delphia, Pennsylvania 1 9 HO. 



or another and become integrated at na- 
tional and international levels to become' 
the policy-making bodies thai maintain 
the' lewis of excellence which have char- 
acterized out profession from the begin- 
ning. We now find ourselves virtualb 
.1 profession of organizations that should 
fulfill e\ ei \ a< ademi< , intelle* tual, social 
and political need ol the physic ian. I o- 
day's instant communication and almost 
instant transportation places every phy- 
sician in instant contact; yet, the number of 
organizations is phenomenal and if one 
wishes and has the time and money, he can 
be a full-time attender of meetings. 

Why then, in the- organization-filled 

WO] Id ol 1958, Was there the need tO de 

\elop .! small neurosurgical society, in one 
ol the country's lamest urban areas? At 
that time, there existed four major aca- 
demic neurosurgical programs within the 
city of Philadelphia. There was, however, 
vci\ little communication among them. 
I1k'\ might just as well have been prac- 
ticing and functioning 111 dillerent cities. 
The senior neurosurgeons knew each other 
quite well, bui then junior staffs and resi- 
dents were very often only casually aware 
of other neat In neurosurgical wot Ids and, 
most important of all. no one program 
knew what the other was doing. In addi- 
tion, there was no local grouping of neuro- 



281 



282 



I KI 1)1 RI( k Ml R I \(,ll |K 



surgeons to represeni the specialty poliii- 
call\ .11 the state and national levels. Ii 
was line thai lhe\ saw eadi othei at na- 
tional meetings, Inn al lids lime lliey were 
more intent upon sitting and talking with 
old friends from greatei distances, and die 
national societies had little or no concern 
for die local problems ol neurosurgical 
|>i .a I i< e. 

Dr. Rudolph |aeger, Piolessoi ol Neu- 
rosurgery al Jefferson Medical (College, 
was disturbed by this lack ol communica- 
tion within die (il\ and wished lo do 

something about it. It was his Eeeling that 
the years ol provincial rivalry and com- 
petition were coming to an end and he 
fell dial there was a need lot die develop- 
ment ol a local group ol neui osurgeons lor 
die exchange ol ideas, lie discussed lids 
concern with l)i. Michael Scott, Prolessoi 
ol Neurosurgery at Temple University 
Medical School. who supported his 
views. The\, in turn, spoke with Dr. Robert 
(.roll, Prolessoi ol Neurosurgery at the 
University ol Pennsylvania, and I)i Vxel 
Olsen, Prolessoi ol Neurosurgery al Hah- 
neniann Medical College. The upshot of 
this conversation was that these four men 
held .in impromptu dinner at a Greek 
resturanl in downtown Philadelphia early 
in 1958. The) were unanimous in the 
opinion that a society should be formed 
within die cil\ to Eostei the specialty ol 
neurosurgery and to develop closer inter- 
professional relationships for the practi- 
tioners ol this specialty. Ii was also their 
feeling that, in order to insure the partici- 
pation and membership of all neurosur- 
geons in Philadelphia in the society, Dr. 
Charles Harrison Frazier (1870-1936), for- 
merly Professor of Neurosurgery at the 
University of Pennsylvania and a pioneer 
in the specialty, should be the patron of 
the society and that its presidency should 
be on a seniority basis, beginning with 
Dr. Francis Grant as first president and 
Dr. Temple Fay as first vice-president 
and president-elect. It was obvious that 
they needed a workhorse for this embryo 



organization, and by some means which I 
have never been able to ascertain, I was 
selected to be secretary-treasurer. This 
was a most fort nitons decision foi me be- 
cause it gave me the opportunity to meed 
know, and become friends with many col- 
leagues whom I might not otherwise have 
had die- opportunity to see. In addition, it 
led to the line experience of helping to 
develop a medical organization from the 
\ ei \ beginning. 

I In Inst formal meeting of the found- 
ers' group was held at Weber's Tavern on 
Montgomery Avenue, Ardmore, Pennsyl- 
vania, in the fall of 1958. Dr. Francis Giant 
presided; Dr. Temple Fay was vice-presi- 
den( and Dr. Frederick Murtagh was secre- 
tary-treasurer. Drs. Rudolph Jaeger, Rob- 
in (.roll, Michael Scott and Axel Olsen 
formed the initial Council of the organi-f 
zation. The first order of business was for 
each nieinbei present to contribute ten 
dollars, not only to pa\ lor the meal, but 
also to start the treasury. There was no 
cjuestion among these present that the 
society should be named the "Philadelphia 
Neurosurgical Society," and that the late 
Dr. Charles Frazier should be its patron. 
Discussion of the scope of the organization, 
however, led to some differences of opin- 
ion. It was obvious that if the group was 
confined to Philadelphia neurosurgeons 
there would hardly be enough members to 
form a good journal club and that the 
group might not survive because of lack of 
strength. It was evident that the neurosur- 
geons in Pittsburgh, Wilmington, Balti- 
more, and Washington, D.C. shared die 
same lack of communication with us and 
with each other within their cities. In 
addition, there were a number of neuro- 
surgeons practicing in main communities 
outside of the large urban areas. It was 
agreed that invitations to join the organi- 
zation would be extended to neurosurgeons 
in this geographical area and, if enough 
interest was generated, the scope of the 
organization could include the region of 



I'llll Mil I I'll! \ \l ( R.OS1 R.GK \l SO( M l J 



283 




FlC. I. Photograph (akin al the lirst general meeting of tin- Philadelphia Ni'iirosurgica] 
Society, Jefferson Medical College, Max l">, 111.")!). Scaled (left to right): Drs. Rudolph 
[aeger, remple Fay, Robert (.mil. Standing (left to light): I)is. Michael Stoti, Frederick 
Murtagh, fr. 



Pennsylvania, New fersey, Delaware, Mary- 
land, and Washington, D.( I. 

The In si general meet in» oi the Societ) 
was held on Ma\ 15, 1!).")!) at the Jefferson 
Medical College. Dr. Francis (.rant pie- 
sided ovei the scientific session, which was 
a Symposium on Pain. The meeting was 
attended In :!!) neurological surgeons, not 
onl\ from Philadelphia and other loca- 
tions in Pennsylvania, hut Erom New fersey, 
Delaware, and Washington. D.C The 
dinnei which followed the scientific ses- 
sion was held at the Benjamin Franklin 
Hotel and presided over by Dr. Temple 
Fa) in Dr. (.rant's absence. At its business 
meeting, the organization was ratified by 
all members present, who became the 
charter members ol the organization. Ii 



was voted to reiain the name "Philadel- 
phia Neurosurgical Society" in spite ol 
the wider geographical distribution ol its 
membership. 

The Society thrived and flourished, 
becoming a loi inn lot local neurosurgeons 
to express theii ideas and to know each 
other better. It also became the recog- 
nized organizational both ol neurological 
surgeons al each ol ilit- pertinent state- 
levels. 

1 1 was policy to have two meetings per 
year. The spring meeting was usnalh held 
at the home-base of the president. The 
first eleven presidents were chosen in order 
of seniority: 

1. Dr. Francis Grant, University of 
Pcnns\ ha nia 



284 



I Rl DI.KK k Ml K I |K 



2. Dr. Temple Fay, Temple University 
.S. Dr. Rudolph faeger, Jefferson Med- 

i< a] ( College 
I. Dr. Hugh Fulcher, Georgetown Uni- 

vei x i i \ 

5. Dr. fames Watts, George Washing- 
ton Univei sity 

(i. Dr. Robert (.roll. University ol 
Penns) Ivania 

7. Dr. fames Arnold, University ol 
Mar) land 

S. l)i. Slew, ul Roue. University ol 
Pittsburgh 

'). Dr. Michael Scott, Temple Univer- 
sity 

10. Dr. William Speuee, Washington, 
DC. 

11. Dr. Axel Olsen, Hahnemann Med- 
ical College 

The practice ol naming the president 
In seniority was easy at In si because there 
were so lew neurosurgeons that then se- 
niority could easily be established. 
More recently, however, the establish 
men) ol seniority has become nunc diffi- 
cult when sometimes only a week or a 
month or two would separate the candi- 
dates lot presidency. This practice was 
therefore abandoned in 1969, and it is 
m\ honoi and privilege to be the In si 
elected president of the Society. 

I'he I. ill meetings ol the Society were 
usually called at the invitation of one of 
the members. Consequently several inter- 
resting meetings were held in Wilming- 
ton. Delaware, and Allentown, Harris- 
burg, Hershey, and Sayre, Pennsylvania. 

In 1962, the Pennsylvania State Med- 
ical Society invited us to meet in con- 
junction with their fall meeting. This was 
done for three years. We found that this 
practice more or less dictated the time 
and place of our meeting, as well as the 
format, and so it was discontinued in 
1965. 

My tenure as secretary-treasurer lasted 
from 1959 until 1966. As we were writing the 



by-laws and constitution, I was careful to 
have it read that the secretary-treasure! 
could serve for three years only and not 
succeed himself. At the end of my first 
three years, however, I found that this state- 
ment was mysteriously missing at the time 
the bylaws and constitution were accepted 
by the Society. It was my pleasure, therefore 
to serve for another three years. However, 
since I have strong personal convictions 
thai no one pe rson should be in such a 
position for more than seven years, I re- 
signed in 1966 for the good of the Society 
and was succeeded by Dr. Arthur li. King 
of Sayre, Pennsylvania. 

As the Society grew, it became increas- 
ingly involved as a policy-making body 
at the state level with problems relative 
to the practice of neurological surgery. 
This woikcd well for the Pennsylvania 
members, but it became rather cumber- 
some lot neurosurgeons in Delaware, 
Maryland, New Jersey and Washington, 
D.C., to state that they were represented 
by the Philadelphia Neurosurgical So- 
ciety. The name Philadelphia Neurosur- 
gical Society had been challenged several 
times because of the geographical scope of 
the organization. Each time the question 
arose, however, it was decided to retain 
the name in honor of the origin of the 
group. An additional problem arose with 
its confusion with the more venerable 
Philadelphia Neurological Society. And 
to confuse matters even more, in 1964, I 
was not only secretary-treasurer of the Phil- 
adelphia Neurosurgical Society, but also 
served a term as president of the Phila- 
delphia Neurological Society. 

In 1967. the matter came to a head and 
it was obvious to everyone that a more 
appropriate name would be "The Mid- 
Atlantic Neurosurgical Society." There- 
fore, in 1967, the former Philadelphia 
Neurosurgical Society passed into history 
to meet the changing needs of growing 
membership. 



Dr. Max Pcct and His Contributions 
to Neurosurgery 1 



/>v IM II I.I I' I ). ( ■( >KI >Y, m i) 



II is quite appropriate that the profes- 
sional accomplishments and the in- 
triguing man thai was Dr. Max Minor 
Peel he discussed at diis meeting <>l the 
medical history section of The College of 
Physicians <>l Philadelphia, rhough Dr. 
Peet was a graduate of the University of 
Michigan Medical School in the Class of 
I910, he received his postgraduate training 
in surgery al the Hospital of the Univer- 
sity of Pennsylvania in Philadelphia w here 
he worked with Di. Charles II. Frazier. 
As a result of this expel ieiu e, he developed 
an earl) interest in the surgeiy of the ner- 
vous system. 

He returned to the University ol Mich- 
igan in I916 a> an Instructor in Surgery. 
The limited amount ol neurosurgery done 
al thai time was carried oul In Dr. Peet. 
B) he confined his ellorls to the sin - 

gen ol the nervous svstem and. in I<>30 
he was named Professoi ol Surgeiy in 
c harge of the Division of Neurosurgery. 

His two major areas ol interest were the 
surgery of tic douloureux and his proce- 
dure ol splanchnicectomy for hypertension. 
He learned the procedure of differential 
section of the sensory root of the trigeminal 
nerve under Dr. Frazier, and he became 
an acknowledged master ol the procedure. 
He devised the operation ol splanchnicec- 
tom) loi reliel ol hypertension and even- 
tual!) (.ni ied out over 1800 of these pro- 
cedures. 

The major interest of a scientific nature 
which Dr. Peel had aside from neuro- 

1 Section on Medical History, The College of 
Physicians of Philadelphia. 18 November 1969. 

-Professor and Chairman. Department of Neuro- 
surgery, Jefferson Medical College, Philadelphia, 
Penns) Ivania 19107. 



logical surgeiA was ornithology. I his in- 
terest began in high school and continued 
throughoiii Ins life. He was responsible 
loi numerous original observations and 
eventually acquired the largest private 
bird collec i ion in the world. 

To those of us who trained under him, 
Dr. Peet will be remembered noi only as 
a master surgeon, but also as a vei \ human 
person with a keen sense of humor, some- 
times needling, bill always kindh, towaid 
his "bo\s." 




Fig 
(1885- 



I'hotograph of Dr. Max Minor Peet 



1949). 



285 



The Massa Hoax 1 



By R V )l< I ( )\ I [ALL, m.d 



DR. GIANAKON, distinguished Fel- 
lows ol (he College .iikI honored 
guests . . . higher primates all. 
Perhaps never before in the hisioi\ ol 
I he College ol Physicians of Philadelphia 
has a guesl speaker been so accurate when 
I sa\ thai ii is with humility and an aware- 
ness ol undeserved privilege and dubious 
honoi thai I am here tonight. Behind the 
august facade ol the College resides a warm 
sense ol humor . . . and I thank you. 

The title which appears on tonight's 
program is The Massa Hoax; 1 1 it- unpub- 
lished subtitle is. The Day We Made 
Monkeys of Ourselves and Some Others. 

Monkey business is nothing new to the 
medical profession <>t to any other area ol 
human endeavor. In fact, it we believe 
uhal Desmond Morris tells us, and main 
of us had come to the same conclusion 
before the printing date ol Hie Xaked 
Ape, all human business is monkey busi 
ness. Ii is small wonder, therefore, thai 
.in ape sioix like ouis generated as much 
human interest as ii did. Retail, if you 
will, the- most popular cage at the ZOO, or 
the best act in the- menagerie. And, 
ol course, there has never been any- 
thing to top c inema's King Kong. 

Our monkeyshines started quite inno- 
cently at the scrub tanks of the neurosur- 
gical operating suite in the Hospital of the 
University ol Pennsylvania. In the early 
morning hours of a bleak Thursday after 
a grim Monday, Tuesday and Wednesday, 
the other residents and 1 were discussing 
the surgical approach to a pending case. 
The head scrub nurse uncoupled my train 

1 Section on Medical History, The College of 
Physicians of Philadelphia, 18 November 1969. 

- Department of Neurosurgery, Hospital of the 
University of Pennsylvania, Philadelphia, Pennsyl- 
vania 19104. 



ol though) with hei customary inquiry! 
"Notion, what's on the schedule for to 
tnoi row?" 

\i thai point in lime 1 couldn't tell her, 
bin i his was unacceptable. So, she persisted 
to inquire. In desperation, to get her off 
m\ b.nk, I turned slowly and deliberately 
from the sink, glared across the top of my 
mask, and said "Would you believe it, 
a gorilla?" 

Her lower jaw dropped bom a grinless 
lace and hei eyes seemed to get bigger. It 
was truly a look ol shocked belief. She 
look a hall-step backward, tilted her head 
to the side and said, "I never know when 
to believe you. But I won't believe it un- 
til 1 see it on the O.R. schedule." It was 
ai that moment that the Massa Hoax was 
boi n. 

We then entered the operating room, 
gowned and gloved, and began the opera- 
lion. Our worried nurse scampered into, 
around, and out ol the room, back and 
forth, as head O.R. nurses are wont to do, 
and engaged in conversation with the anes- 
thesia resident, as they are also wont to do. 
The subject ol the conversation was to- 
morrow's case: an operation on a gorilla. 

I iniisi admit that il was as a result of 
listening to their conversation with one ear 
thai I picked up enough information to 
make my gambit plausible. I had com- 
pletely forgot about Massa (Figure 1); I 
didn't even remember his name. I had 
not seen the story in the newspaper about 
his recent surgery. I didn't even know that 
he was sick. 1 was also unaware of the fact 
that two of our staff men, one from anes- 
thesia, the other from otolaryngology, had 
participated in the operation to drain 
Massa's infected paranasal sinuses. It was 
the anesthesia resident who indirectly in- 
formed me that Massa was the oldest liv- 



L'liu 



I 1 1 1 \l VSS \ HOAX 



287 



i 1 1 14 gorilla in (.i|)ii\n\ .iikI thai his vital 
statistics included 300 pounds "I weighi 
and (3 feet of hci,s» h t. "Oh yes, and his hair 
is S iii( I it's in length," added the 11 111 sc. 

Immediately after surgery, 1 weni t » ► 
the schedule board and wrote in the name 
fMassa" undei "Patient" and "Right 
frontal craniotomy" undei "Procedure." 
I'oi the patient's location, I scribbled, 
••Room 200," making the "2" look like a 
"Z." With .is much nonchalance as I 
could muster. I went back to the scrub 
nurse and told her to check the schedule. 
r>\ (his time she was no longei surprised. 
She hail ahead} convinced herself, as well 
as a lew ol hei friends, thai we were, in 
lac t, going to operate on Massa. 

I explained, lot the benefit ol the skep- 
tics, that Massa's frontal sinusitis had 
worsened and eroded through the base of 
the skull, forming .1 brain abscess. Since 
the University of Pennsylvania had figured 
prominently in his earlier management, 
by cooperative efforts between the School 
of Veterinary Medicine and our Depart- 
ments of Anesthesiology and Otolaryngol- 
ogy, it was only reasonable that we in the 
Departmeni ol Neurosurgery should be 
consulted for the obvious complication at 
hand. "After all, human medicine and 
monkey medicine are not that far apart. 
Don't \ou remember Able and Raker?" 

All of this was accepted at face value, 
as well as the need for doing such deli- 
cate surgery in familial surroundings with 
0111 own instruments and nursing team 
and our own anesthesiologists. And, "Fur- 
thermore, only Oscar knows how we like 
our heads shaved." 

I then went to two stall men in anes- 
thesia who cover our service to explain the 
real situation and to request their in- 
dulgence. The story tweaked their fancy, 
and they both became accessories before 
the fact. 

Thus the plot was laid and thickening 
by the minute; by 3 P.M. that afternoon 




FlG. I. Photograph of Massa the gorilla, age 'M 
years. (Courtesy of the Zoological Society of Phila- 
delphia.) 

the silicic. il schedule was printed and cm 
culated. Operation Massa was launched! 

There were main calls throughout (In- 
day concerning details thai had to be con- 
sidered to ensure a successful outcome lot 
surgery. "What about the lice and the 

fleas?", one asked. "Oh," I said, "thai is 
no problem. We'll put him in a large 
plastic bag with just his head and an aim 

sticking out." "What aboul the table, is it 
big enough?", another queried. 1 said, 
"We plan on using two tables, side by 
side." 

"Where was he to go after surgery, to 
l.G.U. or to the usual Recovery Room?" 
"Who would be selected from the nursing 
registry i<> be the private duty types?" 
All ol these and many other matters had 
to be considered and resolved. We had no 
idea that there was actual competition 
between the nurses ol the Recovery 
Room and the I. CI '. Kac h group thought 
that they could give better care than the 
other. To grease our palm, the Recovery 
Room people granted us the use of an 
entile bay. the one with all the monitor- 
ing devices for anesthesia researc h. 

Our plan of attack was quite simple. 



288 



R. NOR I C)\ II \l I, 



Massa was to come to the hospital on the 
morning ol surgery, aftei the rush houi 
traffic, ol course, in the ha< k ol .1 large 
van with a hydraulic tailgate lift. He was 
to have chains on both ankles and wrists, 
as well .is one around his neck. He was 
io he escorted by five chain men and his 
Eavorite handler. Massa would entei the 
hospital complex llnough the hack en- 
trance and would ascend to the operating 
loom suite by way ol the height elevator. 
He was lo he walked, or whatevei gorillas 
do. down the hallway in his new plastic 
siiii lo O R. Id wheic he would he coaxed 
onto the two tahles and would then, on .1 
given signal h\ his lavoiilc handler. ex- 
tend his .11111 docilely so anesthesia could 
he indue eel intravenously. 

Obviously the patient would he N.P.O. 
Erom midnight before, and he would be 
given no sedation lor leai ol 1 1 1 «. - deadh 
combination ol increased intracranial 
piessure and respiratory suppressants. 

Oscar, the ne ui osui gic al orderly, who 
positions and shaves .ill ol oui patients, 
had been forewarned. Thus he became 
Eorearmed In collecting no less than seven 
surgical prep trays to assure a good job in 
baring the ape 's arms and seal]). 

The woid had spread, apparently, and 
volunteers to scrub from the ranks ol the 
nurses, medical students and interns, were 
last accumulating. F01 those who didn't 
think the) had a chance to have a hand in 
tlit- opeiaiion, places ol ohservation were 
marked in the' O.R. and were jealously 
claimed. There were sixty such places 
arranged by Friday morning. 

Not to be outdone, the Department of 
Radiology was on record to render what- 
ever service it could in the way of skull 
films on the morning of surgery. And, in 
fact, at one point the) had a few people 
looking through their department for Dr. 
flail and Massa who were both down I01 
skull x-rays. 

By this time, an attest to the efficacy of 
the hospital grapevine, not only were the 



professional and paramedical personnel 
informed, and in some depth, hut so were 
some eil the patients. One ihoughilul pri- 
vate patient on our service called the Wil- 
liam Penn Shop and iccpiested that a 
bunch of bananas he delivered to Massa 
posl-opeialivcly, in care ol the University 
I [ospital. 

Thai night when 1 went to bed, 1 
thought the Massa incident would also 
sleep. However, the next morning, the 
operating suite was alive with cameras and 
people. It was obvious that some had never 
before been in an operating room: many 
wore scrub suits, caps and masks in place 
over their street clothes. The place was 
abuzz with activity and excitement in antic- 
ipation of the moment ol Massa's arrival. 
Meanwhile, in the neurosurgical area, 
Oscar was having some serious second 
thoughts, and the other orderlies, those 
who could be found, were on the verge of 
mutiny. 

It was time, 1 thought, to let the mon- 
key out ol the bag, so to speak. 1 called 
a hurried council of war with the rest of 
the residents. It was decided that I should 
go to the- master O.R. schedule, draw a 
broad pencil line through Massa's name, 
and pi int in big letters "Cancelled." It 
was also decided that a story of explana- 
tion was needed, one that would mull the 
disappointment of believers. So, once again 
we concocted a story. 

You see, as I stated earlier, Massa had 
been X.P.O. since midnight. The truck- 
driver made a wrong turn and brought 
the van to a halt, not behind the Ravelin 
Building, but behind the Food Services 
Building where the aroma of fried bacon 
and fresh coffee enriched the already 
scented atmosphere of early morning 
Philadelphia. A\ lien the doors of the van 
parted, the starved beast had an uncal fit 
and hurled his handlers about in a rage, 
rendering the entire situation unsafe for 
both man and beast. Only with great 
effort was Massa subdued and locked into 



I III M \ss\ How 



289 



the van. With sadness, the powers that be 
decided to cancel surgery for today. They 
would try again another time, but next 
time at the /no. 

Apparently this story was accepted, 
and with gusto, for by the time it had 
worked its way off the O.R. floor f didn't 
recognize it. ft seems that someone had 
reported visiting the Receiving Ward and 
finding it a shambles. We heard there 
were people lying all over the place with 
chain marks on their heads and torsos, 
beaten into near senselessness by the en- 
raged and starved gorilla. 

After this misreport, we thought that the 
event of Massa's craniotomy had come 
and gone, and was, for all intents and pur- 
poses, over. We returned to our daily 
routine with a chuckle. 

Later that day, I was summoned to the 
Office of Public Relations to explain the 
sudden increase in telephone calls to the 
hospital inquiring about Massa, his diag- 
nosis and post-operative condition. So I 
explained the hoax. Before I was finished, 
however, the P.R. girl was on the phone 
to a "friend" on the staff of the Evening 
Bulletin. He was interested in clearing up 
the matter, not on reporting it. The City 
Editor had been given a tip by a reliable 
informant but couldn't track down the 
story. Since it was nothing more than a 
hoax, he was sure that it wasn't news- 
worthy. With reassurance that I had finally 
squelched the tale, I left, again convinced 
that I had seen and heard the end of the 
Massa hoax. 

The next day everything seemed back to 
normal. Rounds went as usual and spirits 
were high. The neurosurgical residents 
agreed that it had been a good joke, and 
that the best part of it was its harmless- 
ness. 

Later that afternoon, while napping in 
the on-call room, I was awakened by a 
telephone ring. It was an outside long 
distance person-to-person call from, ac- 
cording to the voice at the other end, the 



Mike Jackson Show from KABGTV in 
Los Angeles, California. As she talked I 
heard the time beep, yet was convinced 
that someone was playing a joke on me. 
I hung up, telling my caller that I was 
very busy, but that may be at a later date 
we could talk about it over a drink or two. 

I went back to sleep, only to he awak- 
ened shortly by another call, this time 
from a recognizable voice. It was one 
of my residents who claimed to be reading 
from a newspaper story about Massa. I 
bolted out of bed and was immediately 
awake, taking a shower in my own cold 
sweat. Despite my initial reaction, I was 
still not convinced of the validity of this 
call cither. I decided to make myself 
scarce for awhile. Naturally, the first place 
I went when I left the confines of the 
hospital was to the local newsstand. 

There it was, on page one, in headlines: 
"CRANIOTOMY ON MASSA— JUST A 
SURGEON'S JOKE." The spoof was on 
the hourly newscasts throughout the day 
and apparently made the national wire 
service. It was also the funny ending for 
the 11 P.M. local TV news. Since that 
time I have received numerous letters from 
all over the United States and its terri- 
tories, telling me of the appearance of our 
gorilla story. A few writers have enclosed 
newspaper clippings. 

To date, the farthest newspaper known 
to carry the story was Puerto Rico's San 
Juan Star, delivered to Saint Croix in the 
Virgin Islands. Moreover, friends are still 
sending me pictures of apes and the O.R. 
nurses have presented me with a small 
plaster gorilla with his hands holding his 
head. 

The Philadelphia Zoological Garden, 
this country's first and best zoo — related 
not only by parentage, but also by con- 
tinued happy association to the Univer- 
sity of Pennsylvania — has remained 
friendly. Their public relations depart- 
ment has provided a display for the Col- 



290 



R. NORTON HALL 



lege foyer and Dr. Fred Ulmer personally 
took a color photograph of Massa for to- 
night's talk. I assume that the gate receipts 
increased at the zoo for two weeks after 
the craniotomy story. 
In conclusion, I suppose that the Massa 



hoax was a personal experience of more 
worth than I can now appreciate. For it 
was my first encounter with practical an- 
thropology and group dynamics. The only 
expressible insight derived therefrom is: 
"Well, I'll be a monkey's uncle!" 



Multiphasic Health Testing 1 

By JOSEPH H. BOUTWELL, ph.d., m.d. 2 



I WANT to thank the Pennsylvania 
Public Health Association and the Sec- 
tion on Public Health of The College 
of Physicians for the pleasurable oppor- 
tunity and the high honor which was be- 
stowed upon me, through your Program 
Committee, when I was invited to speak 
to you today. 

Although I come to you from Atlanta, I 
am honored to claim a number of you in 
the audience as friends. Dr. Claude P. 
Brown, whom I met soon after I arrived in 
Philadelphia in 1949, was very thoughtful 
in sending me an assortment of printed 
memorabilia of Dr. Arthur Parker 
Hitchens, in whose memory we are gath- 
ered here today. I never had an opportu- 
nity to meet Dr. Hitchens, as his death oc- 
curred in December of 1949, only six 
months after I started my appointment at 
the Department of Biochemistry of Tem- 
ple University Medical School. Dr. Hit- 
chens was a laboratorian, a bacteriologist 
and a public health epidemiologist. He 
had, I deduce from his activities, a strong 
sense of the professional community of 
understanding which is a necessity for 
scientific communication. His leadership 
in the founding of Abstracts of Bacteriol- 
ogy, his support of Biological Abstracts, 
his contributions to Bergey's Manual and 
to the Diagnostic Procedures and Reagents 
of the American Public Health Associa- 
tion all attest to this, as do his efforts in 
the publication of The Journal of Bac- 
teriology. His wife, Ethel Bennet Hitchens, 

•Arthur Parker Hitchens Lecture XIII, The Col- 
lege of Physicians of Philadelphia, 8 December 1969. 

2 Chief, Licensure and Development Branch, Lab- 
oratory Division, U. S. Department of Health, Ed- 
ucation, and Welfare, Public Health Service, Health 
Services and Mental Health Administration, Na- 
tional Communicable Disease Center, Atlanta, 
Georgia 30333. 



has insured that The College of Physi- 
cians will continue to be able to maintain 
that journal in the College library. 

It is perhaps fitting that a clinical chem- 
ist be recruited to discuss multiphasic 
screening, a technique or procedure 
which, it is hoped, will contribute to the 
ability of the health profession to control 
long-term (or chronic) illnesses in the same 
way that the diseases associated with mi- 
crobiological causes have been controlled. 

The purpose or purposes of multiphasic 
health testing should be clearly under- 
stood. Unless the purpose (the end result 
sought) is very clear to all (including those 
concerned in the required secondary sup- 
plemental decisions), much confusion and 
waste can result. 

First, let me outline what I consider to 
be included in multiphasic health testing. 
In addition to the bookkeeping necessities 
for patient identification, the first phase 
of multiphasic health testing includes a 
review of past medical history, family his- 
tory, personal habits, and a pertinent 
interval history of changes in those items. 
Such information may be obtained by 
various time-saving techniques, such as a 
self-administered questionnaire. 

The second phase of the system com- 
prises programs for system and organ 
testing. Supplementing the procedures used 
in the collection of data for these systems 
are laboratory testing methods. 

The mere enumeration of the systems 
to be examined shows that some economy 
of effort and design must be relied upon 
to insure a workable system of multiphasic 
health testing. The decisions needed to 
direct the procedure effectively can be 
guided by examining the purposes of 
multiphasic health testing. 

The most obvious purpose is to bring 



291 



292 



JOSEPH H. BOUTWELL 



to bear upon each member of the pop- 
ulation those medical and laboratory pro- 
cedures now known to be helpful to the 
physician in detecting and monitoring 
disease. This is to say that even without 
the development of new medical criteria, 
without any new diagnostic aids, our pres- 
ent techniques can be more widely and 
effectively applied to detect unknown or 
untreated disease. The same purpose is 
served by surveillance of healthy individ- 
uals and of patients known to have de- 
fined diseases such as hypertension and 
diabetes. 

Physicians can effectively use the same 
type of multiphasic health testing for their 
office practice, for preemployment and 
periodic health examinations, for insur- 
ance examinations, and also for pread- 
mission workups of patients to be hos- 
pitalized. 

To fulfill these specialized purposes and 
to provide for in-depth investigation of 
abnormalities revealed during the test 
period, routine multiphasic health test- 
ing should include a fairly large number 
of more specialized sub-routines, such as 
examinations of high risk groups. 

The present great interest in multi- 
phasic health testing stems from a diver- 
sity of purposes based on beliefs, hopes, 
and concerns, some of which are well 
founded. Others, I believe, presuppose 
the existence of certain non-existent in- 
formation. Here are some examples: 
1. It is believed that there is at present an 
inadequate application of present tech- 
niques. 

Multiphasic health testing is proposed 
as the mechanism by which our present 
medical capabilities in disease detection 
and treatment may be more effectively 
and economically applied. This may be 
true. On the other hand, the present 
system of physicians' offices, clinics, 
neighborhood health centers, and other 
approaches combined with more cen- 
tralized laboratory services may afford 



a better utilization of resources. The 
social and economic consequences of 
ill-considered choices between alterna- 
tives may be serious. 

2. It is believed that technological de- 
velopments in laboratory and diagnostic 
apparatus have lowered costs. 
Undoubtedly, in the last 15-20 years, 
enormous strides have been made and, 
in some cases, the cost of a single analy- 
sis has decreased significantly. Caution 
in interpreting this fact must be urged, 
since the lowered costs have generally 
resulted only in more tests on any given 
patient. The increased technological 
capacity has not been applied to dis- 
ease detection in populations. Thus, the 
capability of significantly extending 
case finding by these means has not 
been tested. It should be recognized 
that the requirements and techniques 
and procedures are quite different for 
these two applications. 

3. // is believed that technological de- 
velopments have increased accuracy and 
precision. 

Automation has been shown, rather con- 
clusively, to increase precision, or the 
reproducibility of the results of clinical 
laboratory tests, when the process is 
well controlled. This advantage, how- 
ever, is not an element which accom- 
panies the instrument as an integral 
part of the product. It is rather a po- 
tentiality which can be achieved only 
by knowledgeable, experienced analyt- 
ical personnel. The more "sophisticated" 
analytical instruments, even those more 
recently developed, depend heavily upon 
calibration reference materials and 
standardization techniques of dubious 
parentage, and these instruments re- 
quire even greater degrees of profes- 
sional acumen for accurate and de- 
pendable results than do classical 
methods. The report of the recent sym- 
posium on Multiple Laboratory Screen- 
ing underlines this problem by stating 



Mil/urn ask: m ai in i rs mm, 



293 



that the "precision and accuracy of 
present analytical methods are limiting 
our ability to use this approach." 
What are the beckoning possibilities 
which multiphasic health testing, or mul- 
tiple laboratory screening, places before 
us? First, the possibility that by well or- 
ganized use of the resources for diagnosis 
and treatment, a greater number of per- 
sons with disease may be diagnosed and 
treated. Second, the possibility that with 
earlier detection of disease and more fre- 
quent and effective monitoring of disease 
treatment, the effects of disease on the 
patient may be minimized. Third, the 
possibility that this system of coordinated 
approach to health care may lead to more 
effective diagnostic tests or to more useful 
combinations of presently existing labora- 
tory methods. An example of the former 
is the test of newer methods of detecting 
breast carcinoma organized by the Health 
Insurance Plan of New York and, of the 
latter, the efforts of Files and Lindberg 
at the University of Missouri. 

A number of relatively well defined pro- 
fessional responsibilities are yet to be as- 
sumed, discharged, and assimilated into 
the medical diagnosis and treatment cul- 
ture before this most intriguing prospect 
of multiphasic health testing can be re- 
garded as within our grasp. Most vitally 
important is the improvement of the ac- 
curacy and precision of the laboratory 
methods and other procedures used to 
accumulate the primary data upon which 
the physician must base his interpreta- 
tions. 

This next step will be to enter upon the 
task of defining "normal values" for dis- 
tinct populations with the variants of age, 
sex, dietary history, etc., in a way similar 
to that taken by an earlier generation in 
defining a "normal BMR." Once the limi- 
tations of laboratory error and inadequate 
definitions of the normal range are re- 
moved, we can move on to the next step: 
the definition of normal values (and their 



range) for each individual. Deviations 
from one's own individual values may 
assume great importance in the early de- 
tection of disease. The last step, which is 
already being explored, is the detection of 
disease by slight alterations in the pattern 
of normal relationships between several 
test results. 

These beckoning possibilities are so in- 
triguing and so enticing that we may well 
overlook, indeed some very influential 
leaders are presently overlooking, the im- 
mense scientific labor and investment neces- 
sary to build the required firm foundations. 
I am very concerned that in our apprecia- 
tion of the desirability of the more distant 
goals, we do not fail to see that the very 
next immediate tasks are begun. Already, 
the market place is replete with analyt- 
ical instruments and systems, reagents, 
and devices inadequately designed and 
tested which can only deliver informa- 
tion of poorer quality than do the clas- 
sical methods. There seems to be a philos- 
ophy that a large amount of low quality 
(low in accuracy and/or precision) infor- 
mation is equivalent to a smaller amount 
of high quality data. Although this view 
has some validity in establishing true mean 
values by accurate (if not precise) meth- 
ods, it is not at all useful for individual 
patients. 

Three more general areas should be 
mentioned. First, if the amount of infor- 
mation (both laboratory data and other 
pertinent system review data) is to be 
multiplied manyfold both by having more 
patients and by having and keeping 
more information on each patient, a much 
more effective system of data handling, 
storage, and retrieval must be developed. 

Second, the need for computer assistance 
in interpreting medical and laboratory 
data must be recognized and its use ex- 
ploited. And, third, the need for effective 
management and organization of the mul- 
tiphasic health testing system must be 



294 



JOSEPH H. BOUTWELL 



emphasized. This need for good manage- 
ment practices must be recognized at all 
levels from the narrow base of the day-to- 
day operation of the integrated system to 
its interaction with community health 
problems. Categories of disease must be 
given their proper weight and importance 



in the total concept of community serv- 
ices. Multiphasic health testing systems 
must be optimized not only from the 
viewpoint of how most effectively to de- 
tect, treat and follow disease, but also from 
the viewpoint of the individual's total 
life in the community. 



Philadelphia Medicine in 1841 as Seen by 
a Visiting Physician 



By HAROLD J. ABRAHAMS, ph.d. 

MILO LINUS NORTH (1790- 
1856), B.A., Yale, 1813, M.D. 
(Honorary), Yale, 1834, of Sara- 
toga Springs, New York, visited Philadel- 
phia in the winter of 1841-42 with the 
purposes of enjoying the sights of a large 
metropolis and of enriching his training 
in medicine by learning and observing. He 
attended lectures at the Jefferson Medical 
College and the School of Medicine of the 
University of Pennsylvania, visited the 
famous hospitals of the city and sought out 
the company of its physicians. 

Upon his return to Saratoga Springs, he 
set down his impressions of Philadelphia 
medicine in the form of three "letters," 
and submitted them to the editor of the 
Boston Medical and Surgical Journal, 
where they were published (Volume xxvi, 
1842, pages 5-8, 25-29 and 39-45). He 
gives as his reasons for writing them, that 
he had the itch to write, that he had an 
abundance of free time during the long 
winter when Saratoga had few visitors, 
that it was his wish to tell his colleagues in 
the Northern states something about 
Philadelphia medicine, and, finally, that 
he felt "a sense of deep obligation . . . for 
the professional kindness, liberality and 
attention bestowed on a stranger by the 
excellent physicians" of Philadelphia. He 
remarks: "I do not suppose that my case 
was peculiar. These men must be in the 
practice of giving the hearty welcome to 
those who come in quest of science." 

• Research Associate, Library of The College of 
Physicians of Philadelphia, 19 South 22nd Street, 
Philadelphia, Pennsylvania 19103. Dr. Abrahams 
resides at Wcssex House, St. Davids, Pennsylvania 
19087. 

t Historian, National Institutes of Health, Be- 
thesda, Maryland 20795. 



* and WYNDHAM D. MILES, PH.D.f 

Facts about Dr. North's life are few in 
number. He probably studied medicine 
under a physician and may also have at- 
tended medical school lectures somewhere. 
It is known that he practiced medicine in 
Hartford in the 1830's and moved to Sara- 
toga Springs in 1839. While practicing in 
the latter place, he became a most enthu- 
siastic exponent of Saratoga waters, pub- 
licizing their virtues in articles in the 
Boston Medical and Surgical Journal from 
1 839 — 4 1 and in a small book, Saratoga 
Waters, or, The Invalid at Saratoga, which 
ran through seven editions between 1840 
and 1858 and belonged to the genre of 
other such books by practitioners residing 
in Saratoga and treating its visitors. At 
the time of his death on February 22, 1856, 
at his son's home in Spuyten Duyvil, New 
York, the editor of the Boston journal ex- 
pressed the hope that someone would write 
an obituary notice about him, but an ade- 
quate biographical sketch of Dr. North 
has not yet come to hand. 

North's impressions of teachers and of 
the social customs of physicians evoke a 
picture of the old Philadelphia medical 
scene that is not described in formal his- 
tories and biographies. His chatty, per- 
sonal recollections give a view of Philadel- 
phia medicine as it existed one and one- 
third centuries ago. 

Below are reproduced Dr. North's "let- 
ters," omitting only those portions which 
do not illuminate his impressions of 
Philadelphia medicine of his day. The 
letters capture some of the spirit of 
nineteenth century medical Philadelphia 
and thus constitute a worthy eye-witness 
account of some of the phases of medicine 
in the middle decades of that century. 



295 



■2'u 



HAROLD J. ABRAHAMS AND WVNDIIAM D. MILES 



On Wednesday, 27th October, 1841, I 
took up my residence for the first lime in 
the City of Brotherly Love, at a private 
boarding house, corner of Eighth and 
Walnut. Although I was furnished with 
several introductory notes in New York, I 
first sought some of my invalid acquaint- 
ances, and through them their family phy- 
sicians. As my real object, however, in 
visiting the city was the acquisition of 
medical science, whether gained in private 
conversations, lectures, hospitals, libraries, 
museums or medical clubs, I soon aban- 
doned all formality, and without hesita- 
tion made my own introduction when it 
was not perfectly convenient to obtain the 
medium of others. As my name and resi- 
dence had become generally known to the 
physicians through the frequent visits of 
their patients to the Springs, credence was 
readily obtained, and thus needless for- 
mality avoided. During an abode of three 
weeks, I was made unceremoniously a 
guest in the families of several, and at 
many of their private libraries and offices, 
and was admitted to various hospitals and 
to courses of public and private medical 
instruction. I was also politely invited to 
several medical and scientific clubs, of 
which it may be proper to speak in this 
place. 

All the Medical Clubs I attended were 
very similar. Some dozen medical men as- 
sociate and meet once a week at each 
others' houses in rotation, after the labors 
of the day are over. The interview oc- 
cupies say from 8i/ 2 to 10i/ 2 P.M. The only 
absolute rule that was apparent was that 
the refreshments should be rigidly limited 
as to variety. Cakes, coffee and tea and 
biscuit comprised the whole. This, having 
been long and fully settled, exempts the 
family from trouble, and leaves the host 
entirely at his ease and enjoyment. Indeed 
there is not the least awkwardness nor em- 
barrassment in the host's attending to an 
incidental call. These circles were the 
scenes of easy medical and scientific chat, 



without stiffness or any sort of friction 
from regulations; a place of relaxation and 
mutual information respecting the sub- 
jects that would naturally interest a set of 
scientific professional men. The friendly 
feelings generated and enhanced by these 
meetings must serve greatly to lighten the 
anxieties and cheer the labors of the mem- 
bers of the circle. There was not the least 
formality and no organization. Each one 
came and went without ceremony. 

I am thus particular respecting these 
clubs, because I have long been an advo- 
cate of their use in other cities and vil- 
lages. There is scarcely a village so small 
in New England that some dozen men 
might not spend a couple of hours, once a 
week or fortnight, in unceremonious con- 
versation on miscellaneous subjects. In 
cities, physicians can do this. It cannot be 
denied that many clubs have failed. But, 
on inquiry, the cause of failure will be 
found in nearly every instance in the one 
fact that the entertainments were not 
limited, exactly and scrupulously, at the 
commencement. This fault is not charge- 
able to the selfishness, but the generosity 
of the members: and if their families were 
never sick, nor servants difficult to be pro- 
cured, the failure would not occur. 

The Wistar Parties in Philadelphia are 
held every Saturday evening through the 
winter, and are on a different basis. No 
person can be a member unless previously 
a member of the American Philosophical 
Society. This renders it, "per se," a society 
of distinction. They meet from house to 
house, each member bringing a stranger of 
proper character if he chooses. No ladies 
attend. Among the distinguished Phila- 
delphians present, I was proud to see a 
very full representation of our own pro- 
fession. The supper table was very sump- 
tuous for a scientific body, and I deeply 
regret to say that various kinds of wine are 
yet placed on the table. Would these 
noble-looking men, with their bright faces, 
eloquent lips and glowing sentiments, be 



PIIII.ADF.I.IMII \ MEDICINE IN 1 HI 1 



297 



more likely to withdraw from these social 
gatherings if the wine should he dismissed 
and the multiplied hospitalities of the sup- 
per table be reduced to a simple repast? 
Do I wrong these men, to whom I stand 
indebted as an obliged guest, by supposing 
that, if the secret thoughts of all their 
hearts could be read, it would be found 
that these fellow citizens of Franklin dis- 
claim all connection between wine and 
science, and heartily wish them divorced? 

Before dismissing the subject of clubs, 
indulge me in saying a word about a medi- 
cal association in Hartford County, Conn. 
About 17 years since, several high-minded 
physicians in that county constituted 
themselves into an election society under 
the name of the Hopkins Medical Asso- 
ciation, to embrace all in the vicinity who 
seemed worthy and desirous of member- 
ship. The terms of election were made so 
rigid that it was next to impossible for a 
dishonorable man to gain admittance. 
They have met ever since, once in four 
months, or three times a year. At first they 
went from house to house in rotation. But 
the remoteness of some of the meetings 
from the city, the occurrence of an occa- 
sional stormy day. and the liability of 
sickness in the family of the host, nearly 
destroyed the club. 

At this juncture an intelligent manager 
of a public house in Hartford, considering 
that, owing to the peculiar engagements of 
physicians, the distance of many, and 
stormy days, he could scarcely have an 
average attendance of over half of the en- 
rolled members, offered to give them a 
plain, substantial supper three times a 
year for one dollar a member per annum! 
By this arrangement the public house re- 
ceives say forty dollars a year for about as 
many meals, and some pretty little per- 
quisites from horse-keeping, Sec, so that 
they have given the club a large sitting 
room and a meal three afternoons a year 
for several years, and have never com- 
plained. This arrangement could only- 



have been accomplished in Yankee land, 
but there it may be done in many other 
cities and villages: and if both parties are 
as happy as they have been in tins case, 
they never will regret the undertaking. 
The elective nature of the Society has had 
a palpably beneficial effect on the profes- 
sion out of the club, in restraining them 
from dishonorable practices; and those 
within are clearly much benefited by the 
social and scientific exercises of the club. 
Each meeting has an organized session be- 
fore supper, devoted rigidly to medical 
discussions and improvement: social pleas- 
ures succeed. I commend this Society to the 
consideration of the leading men of our 
profession in the many localities in our 
country that are populous enough to ad- 
mit of such association. 

But, omitting the further discussion of 
clubs, let us pass to a different topic; viz., 
the comparative respectability of the medi- 
cal profession in Philadelphia. I admit, 
most fully, the fallacy of first impressions. 
I know how differently men and things ap- 
pear after a year's acquaintance and ob- 
servation. Still I am confident there can be 
no cause for reconsideration in asserting 
that our profession hold a very high rank 
in that city. Consider that there are three 
flourishing medical colleges in the very 
heart of the city, and near each other, 
either of which would stand high in any 
part of the country. 1 About the first of 
November from seven hundred to one 
thousand medical students and strangers 
are, all at once, to be seen traversing the 
streets and inquiring for the various medi- 

1 The three schools were the School of Medicine 
of the University of Pennsylvania, Jefferson Medi- 
cal College, and the Medical Department of Penn- 
sylvania College. The medical school of the last- 
named college lost its independent existence when 
it merged with the Philadelphia College of Medi- 
cine in 1859, although the name was retained by 
the school which resulted from the merger. The 
new school, likewise, became extinct shortly there- 
after. (See Abrahams, H. J.: Extinct Medical Schools 
of Nineteenth Century Philadelphia. University of 
Pennsylvania Press, I960.) 



298 



HAROLD J. ABRAHAMS AND WYNDHAM D. MILES 



cal offices. This noticeable influx of strang- 
ers makes its proper impression on the 
citizens. It is a matter of commercial and 
social interest. These students scatter into 
many families, and medical men and med- 
ical subjects become legitimate matters of 
discourse. They spend the winter, and leave 
to the boarding-houses, lecturers, book- 
sellers, merchants, private teachers, Sec. Sec, 
many thousand dollars. Even strangers can 
see that medicine is a subject of general in- 
terest in Philadelphia. When comparing 
these flourishing medical schools with 
literary colleges, law schools and theologi- 
cal schools, the difference often appeared 
marvellous. What other distinctions has 
this city achieved except in medical 
science? But, here, all is enthusiasm — all 
spirit. Even men who are not public lec- 
turers, receive large sums for private in- 
struction. To accommodate students rooms 
are handsomely furnished with libraries, 
apparatus, models, &rc, in various parts of 
the city, and thus a promising corps of fu- 
ture lecturers are already in the harness. 
If we inquire how came the Philadelphians 
by these substantial perquisites, the answer 
is obvious; that it was because a band of 
distinguished medical men, whose names 
are familiar to all, took the lead of the 
whole country in medical instruction, and 
have managed, by means of their excellent 
institutions and successors, to keep it. This 
is the simple and undoubted reason. Pro- 
fessor Chapman said, in his introductory, 
that no European physician could gain 
solid footing in Philadelphia until he had 
abandoned all pretensions to curing his 
patients by foreign systems, and had 
adopted the prevailing practice of the city. 2 

2 Nathaniel Chapman (1780-1853), who was de- 
scended from relatives of Sir Walter Raleigh, took 
his M.D. at the University of Pennsylvania (1800), 
then studied in London and Edinburgh for three 
years. It has been written of him that, after Dr. 
Physick, "he was the acknowledged head of the 
American profession." 

Introductory lectures were lectures given before 



And medical students that go abroad are 
forced to abandon mustaches, foreign 
frippery, and foreign systems, on their re- 
turn, and adopt the methods and costume 
of home. 

The dress, equipage and household ar- 
rangements of the physicians of Philadel- 
phia comport with the elevation of their 
character. Indeed, from a slight acquaint- 
ance in Boston and New Orleans, and a 
very considerable one in New York, I 
think the medical men of Philadelphia are 
rather obnoxious to the charge of paying 
too great attention to these things. Their 
fees are very moderate, and complained of 
by themselves. I was told repeatedly that 
scarcely any man, however distinguished, 
charges over one dollar a visit in ordinary 
practice. This is the regular charge in such 
places as Albany, Troy, Utica and New 
Haven. In New York and Boston, men of 
similar distinction charge decidedly 
higher: one dollar and a half in Boston 
and two dollars in New York being the 
common charge of fashionable practition- 
ers. It should be added that there are men 
in both these cities whose services are re- 
warded at a much higher rate, and justly; 
for the plain reason that men of inferior 
talents and responsibilities in other em- 
ployments are compensated much more 
liberally than themselves. It did not de- 
stroy Sir Astley Cooper's acknowledged 
liberality in his profession that he accu- 
mulated a fortune. 3 And who would think 
the worse of the distinguished men of 
Philadelphia, who have, by ardent toil and 
laborious perseverance, made their services 

the actual date of the opening of a school year. 
These lectures provided prospective students with 
an opportunity to hear some of the professors of 
the different schools speak, then choose the school 
which they preferred. A further statement about 
such lectures appears at about the mid-point of 
these letters, below. 

3 Sir Astley Cooper (1768-1841) had perhaps the 
largest practice of any surgeon. In one year he 
earned £21,000. He received one fee of a thousand 
guineas from a rich West Indian planter. 



PHILADELPHIA MEDK [NE IN 1841 



■.><,<( 



indispensable to their wealthy neighbors, 
should they lay up a few thousands for old 
age? Is there any reason in the world why 
a physician or surgeon who renders serv- 
ices of an extraordinary value should not 
be compensated precisely as a lawyer or a 
merchant is in the same case? If an Astor 
or Girard could add a farm to his posses- 
sions by one mental process, should not a 
Physick or a Mott receive extra compensa- 
tion for an equally supereminent, intellec- 
tual exertion? 4 If every body says it is right 
for Daniel Webster to be munificently re- 
warded for securing, perhaps, an estate to 
a family by his great legal knowledge and 
power, shall it be pronounced mercenary 
if his neighbor, Dr. Warren, should re- 
ceive a like generous gratuity for rescuing 
from death some beloved member of a 
family by his surpassing medical skill? I 
truly cannot perceive the difference. Op- 
pression and hard-fisted exactions in our 
profession I deplore. Among the little or 
the great, they are an abomination. And, 
whenever a physician finds himself grasp- 
ing at a higher annual amount of compen- 
sation than men of equal talents receive in 
other employments, he may be sure he is 
wrong, and will be likely to bring reproach 
upon his own profession. 

Constituted, however, as our ranks are, 
with at least double the number of practi- 
tioners needed in our country, the power 
of competition must repress extortion and 
forbid the hope of wealth among the mem- 
bers in general. The late Dr. Miner, of 
Middletown, Conn., used to say that four 
hundred dollars were an annual average 
income for the physicians in that county. 5 

4 Philip Syng Physick (1768-1837) has been called 
"The Father of American Surgery." He taught at 
the University of Pennsylvania from 1805 to 1831. 

Valentine Mott (1785-1865) taught surgery at the 
College of Physicians and Surgeons of Columbia 
University and at Rutgers. 

5 Thomas Miner (1777-1841), medical editor, 
translator and writer, was said to have been one 
of the most learned physicians in New England in 
his dav. 



The statement appears scarcely credible 
when it is remembered that each one must 
keep his horse and equipage. To those 
only who know something of the "get- 
along-ity" of the Yankee character, and the 
collateral aids they can secure, will the 
statement appear other than fabulous. . . . 

Permit me in the next place to call the 
attention of your readers to the MEDI- 
CAL LECTURES of Philadelphia. To 
every physician who visits that city, these 
lectures cannot fail to be a matter of com- 
manding interest. Every chair was filled dur- 
ing my residence there, and the professors in 
each of the three schools seemed, to aught 
that met the eye of a stranger, to be quite 
harmonious. After a most careful scrutiny 
and watching for the developments of 
character in my brethren who are thrown 
into the very rare position of three collat- 
eral faculties, almost within stone-throw of 
each other, appealing to the same public, 
commencing the same probationary ex- 
hibition of themselves in their introduc- 
tories, on the same week, to hundreds of 
candidates who have not yet decided 
which faculty to patronize, depending on 
the impression they make on the young 
gentlemen what success each school is to 
share; under the excitement of all these 
caustic stimuli, I must say that, in the 
mass of these professors, I admired the 
magnanimity of their emulation. I said — 
"depending on the impression they make." 
I do not intimate that the impression from 
an introductory is final or omnipotent. 
The reputation of the Colleges and of 
their respective diplomas, has unquestion- 
ably more influence than the introductory 
lectures. But how long would the reputa- 
tion of either faculty be predominant if its 
members should become remiss and repose 
on the laurels they have already acquired? 

In judging thus favorably of Philadel- 
phia competition, I do not profess to go 
behind the curtains. I purposely ground my 
remarks on what comes up to the eye of a 
stranger. Yet I strongly believe that, had 



300 



HAROLD J. ABRAHAMS AND WYNDHAM D. MILES 



there been much dishonorable juggling, 
trickery and finesse, in inveigling students 
from abroad to this office or that — to this 
or the other institution — it would have 
been apparent to the eye even of a 
stranger, who was admitted with the same 
freedom to their offices. I saw no such ap- 
pearance. The style of the lectures, too, 
was generally of the right stamp. There 
was manifest, occasionally, an over atten- 
tion to the turn of a period, to the polish- 
ing of a sentence, and to the introduction 
of sparkling thoughts. In one or two in- 
troductories, I thought there was some- 
thing slightly theatrical in the manner of 
delivery. When we consider that, at each 
of the introductories, there are always 
enough auditors present, who have de- 
cided to belong to the same school with 
the speaker, stoutly to applaud by stamp- 
ing with their canes, it is greatly to the 
credit of the lectures that they so uni- 
formly prefer the solid, useful and instruc- 
tive, to the brilliant and farfetched. 

The introductory of Professor McLean, 
of the Jefferson College, was a thing 
wholly unique, and defied all classifica- 
tion. 6 He appeared at his appointed hour 
in the amphitheatre, pale, emaciated and 
tremulous, from several weeks' severe 
prostration from malaria, encountered in 
his professional engagements on the banks 
of the Schuylkill. The lecture was in man- 
uscript, as I believe were all the introduc- 
tories. It was his first from the chair of a 
college. He first pointed to his auditory 

The name McLean is, apparently, a misprint 
for McClellan, probably caused by the inability 
of the editor of the Boston Journal to decipher 
North's handwriting (typewriters had not yet been 
invented). Samuel McClellan (1800-54) was Profes- 
sor of Anatomy (1830-32) at Jefferson, and then, 
until 1836, held the chairs of Institutes, Jurispru- 
dence, and Midwifery, and later the chair of Ob- 
stetrics and Diseases of Females, until 1839. There- 
after he engaged in private practice. Dr. North 
must therefore have attended his lecture a few years 
before the date of these letters. (See Gayley, J. F.: 
History of Jefferson Medical College, Philadelphia, 
1858). 



the faculty of the old college, many years 
ago, during his medical pupilage. The 
person, costume, manner and mode of 
lecturing of each professor was described 
so minutely that the various portraits were 
left with great distinctness on the memory. 
The large and attentive audiences of 
former days were depicted, and the deep 
silence and veneration of the pupils 
brought before us in glowing colors. In re- 
verting to himself and to his own class, he 
compared the acquisition of medical skill 
to the pursuit of the diamond. A thou- 
sand blows and many prolonged toils are 
required to break up the quarry; but when 
the gem was won and fairly placed on the 
brow, its distinguishing lustre could not 
be conclealed nor obscured. So the deep- 
laid foundations of medical skill would be 
visible in a man's daily performances. As 
his chair was that of Midwifery, he illus- 
trated the want of this diamond — genuine 
preparedness for the various emergencies 
of the practice — by introducing the young 
physician to his first important obstetrical 
case. He described minutely the young 
lady, her family, education, marriage, and 
her elegant mansion and apartments when 
settled in life and awaiting her confine- 
ment. He took his auditors into her pri- 
vate apartment and showed them what no 
man, not even her husband, had really 
seen, her drawer, her preparations, her 
dresses, Sec, prepared for the little 
stranger. At length the nurse and doctor 
arrive, and the patient is examined. "All 
well." After some hours the face of the pa- 
tient becomes flushed, the complaints are 
more urgent, the hand is frequently 
pressed on the head, and the usual ex- 
pression, "I shall die," is heard. All these 
things appear common to the medical 
man. "But," said the lecturer, "did you 
hear her say 'my head aches'?" "No, you 
did not hear her say 'my head aches.' " 
From not observing this small circum- 
stance, puerperal convulsions follow and 
death closes the first important case of the 



PHILADELPHIA MEDICINE IN 18-11 



501 



young candidate for popular honors and 
employment, not wearing on his person 
the aforesaid diamond of professional 
skill. The description of this scene was so 
graphic that, though most of it was per- 
fectly common, 1 cannot resist inserting 
this very lame representation, although at 
so great a distance of time. I do not know 
that Dr. M. will ever again attempt this 
graphic method. It certainly would not 
bear it frequently. Yet I do not believe 
that any of the introductories were heard 
with more deep abstraction than this. To- 
wards the conclusion, he told the young 
men he would give them a secret. "Make 
yourselves useful, make yourselves neces- 
sary by the undisputed benefit of your 
services, and you may dismiss your fears 
about employment in any business." From 
the irruption of quotations from ancient 
and modern languages, it was evident that 
in the midst of a pressing business in the 
city, he contrived to preserve an intimacy 
with his silent companions on the shelves 
of his study. 

There was one more lecture among the 
introductories, of a very different charac- 
ter, but equally sui generis, and more 
surprising. It was the very lecture, a part 
of which you have already re-printed in 
your Journal. Dr. Gibson's Introductory 
evinced a head that could plan and exe- 
cute, and a heart that had the courage to 
ordain, laws for himself. 7 The common 
conventionality of authors and lecturers 
were as cyphers in his estimation. He pro- 
posed for his subject his own autobiog- 
raphy, not only without acknowledging 
anything improper or unusual, but with 
the declaration that if a man did not 
publish his own merits nobody else would 
do it for him. He began with his early life, 

'William Gibson (1788-1868) studied at the Uni- 
versity of Pennsylvania, Princeton, and the Uni- 
versity of Edinburgh (M.D., 1809), was one of the 
founders of the University of Maryland Medical 
School, and was professor of surgery at the Uni- 
versity of Pennsylvania (1819—55). 



and conducted us to the day and hour of 
the lecture. It was an interesting biog- 
raphy, particularly t<> a medical class: 
and had it been told by another, it would 
have been heard with unminglcd pleasure 
and admiration. During its progress, I 
made many efforts to divest myself of all 
former notions of propriety, and to make 
myself believe that the man who had 
achieved such things in the surgical and 
medical world, and who evinced such un- 
deniable proofs of genius, had not mis- 
judged in striking out a new course for 
himself in interesting and instructing his 
class; and, although I have recurred many 
times in my recollections to the mingled 
emotions of amazement and applause 
which I experienced while hearing that 
lecture, I am still undecided whether Pro- 
fessor Gibson, in addressing six or eight 
hundred young men, many from the South 
and West (himself being a Baltimorean), 
did not gain as much by his unparalleled 
boldness and adroitness as he lost by his 
egregious aberration from the rules of 
modesty. I am sure Professor Gibson 
would not be offended should this sheet 
ever meet his eyes, because there was no 
concealment about his lecture. Its scope 
was explicit, avowed, without apology; 
nay, has been submitted to the public, I 
know not with what modifications by 
means of the press. He closed his lecture 
by a labored and most ingenious represen- 
tation of the advantages of the venerable 
Institution in which he occupied the chair 
of surgery. 

I purposely limit my specification of the 
lectures at the Colleges to these two. It 
would be very agreeable to enlarge on the 
varied excellences of these annual intro- 
ductories; but it would be taking liberties 
with your pages entirely inadmissible. 

I shall trouble your readers with one 
more topic, and that is CLINICAL LEC- 
TURES. In this particular, Philadelphia 
certainly stands pre-eminent. I know from 
personal inspections, often repeated, that 



302 



HAROLD J. ABRAHAMS AND WVNDHAM D. MILES 



the New York Hospital has many advant- 
ages for clinical lectures. The Boston Hos- 
pital, too, from its excellent arrangements 
many years ago, I must suppose to have 
kept on in the march of improvement. But 
the Blockley Almshouse, on the west side 
of (he Schuylkill, contains a pauper popu- 
lation of from two to four thousand; and 
among these, I was repeatedly told that 
four hundred patients is a low number, 
exclusive of the maniacs. Imagine all these 
to be lodged in one range of buildings, on 
moveable beds; and on the same floor with 
these wards, and in a central position, a 
very large amphitheatre constructed with 
every contiguous convenience for opera- 
tions and exhibitions, into the centre of 
which the patients can be brought with 
perfect ease on their beds. Suppose, more- 
over, that the whole of these patients are 
divided between the University and Jeffer- 
son College, each of which Institutions 
has its own resident and consulting physi- 
cians and surgeons; and that these men, 
half on Wednesday and half on Saturday, 
select from their respective wards such 
groups of diseases as are most interesting, 
and exhibit them to their classes with the 
accompanying prescriptions and opera- 
tions. Can such an arrangement fail to be 
useful? I have occasionally mingled in the 
groups of a clinical lecture, standing 
among the beds of the patients in a hos- 
pital. This is well when the circle of pupils 
is small. But at the Blockley, by means of 
the amphitheatre and the blackboard, two 
hundred can share very well the advant- 
ages of a clinical lecture. While sitting in 
their seats, after the patients are carried 
out, the specimens of morbid anatomy, the 
result of recent dissections, are passed 
round to the students, who can examine 
them thoroughly without the hindrance 
of the dissection, and contrast them with 
what they previously saw and heard of the 
disease. At each session about three hours 
are spent; one half devoted to the surgical 
and one half to the medical clinique. The 



respective institutions are not confined to 
their own public lecturers in selecting a 
man for the clinical chair. At the time of 
my visit Dr. Gerhard was giving the medi- 
cal clinique in the chair of the University 
or old school, at the Blockley Hospital, 
which post entitles him to the superin- 
tendence, as a consulting physician, of one 
half of all the medical cases in the institu- 
tion. 8 This appointment was no leap in the 
dark. I cannot resist saying that I have 
never seen a physician who, I should 
fancy, would more resemble Dupuytren, 
in his habit of investigation, than this 
same Dr. Gerhard. 9 I should imagine he 
had long taken up his abode in the hos- 
pitals of Europe. Like many of the medical 
aspirants of Philadelphia, he has served 
his time among foreign hospitals, and, I 
believe, by the side of Dupuytren. Slender 
and erect in his person, with a keen eye, 
and a face undoubtedly made thin by the 
midnight lamp, he assembles his group of 
patients in the middle of the theatre, 
with his auditors on seats rising around 
him, gives a clear and succinct description 
of the disease, enters most fully into its 
pathology, and with a familiarity and 
comprehensiveness that would surprise 
many a veteran practitioner who listened 
for the first time to a clinical lecture, 
comes up boldly to the diagnosis, specify- 
ing the seat and extent of the lesion, and 
clearly distinguishing it from its counter- 
feits; evinces no reserve nor dodging 
while on the prognosis, and discusses the 
methodus curandi on a basis evidently 
eclectic and rational, and drawn from 
prolonged and accurate observations of 

8 William W. Gerhard (1809-1872) was educated 
at Dickinson and University of Pennsylvania (M.D., 
1830). He studied medicine under famous French 
physicians in Paris and from 1834 was resident 
physician and later visiting physician of Philadel- 
phia hospitals. At the time of North's visit he was 
assistant professor of institutes of medicine at the 
University of Pennsylvania. 

"Guillaume Dupuytren (1777-1835) was a famous 
French surgeon, well-known to American medical 
students studying or visiting in France. 



Philadelphia medicine in ihh 



the multifarious plans in Europe and 
America. Bating a slight bearing which I 
thought was apparent towards the expect- 
ant method of the French, the therapeu- 
tics of Dr. G. appeared to be such as our 
best practitioners in Boston, New York 
and Philadelphia would approve. So com- 
pressed and rapid are his statements and 
reasonings, that you have no chance for 
idling, but are dragged on, on to the end; 
and you then feel that there is much that 
the young gentlemen must inevitably lose 
from their want of previous clinical ex- 
perience and practical acquaintance with 
the subjects discussed. 

From attending a single clinical lecture 
of Dr. Pancoast, from the Jefferson Col- 
lege, I think he may be set down as the 
opposite of Dr. Gerhard. 10 Dr. P. is pro- 
longed, exact, particular; and seems re- 
solved that his pupils shall never forget 
the facts of the disease in question, and 
the steps of his operations. These lecturers 
are both good, but yet very different in 
method. 

Of Dr. Gibson, the collaborator of Dr. 
Gerhard, I have already spoken. Surgery is 
his passion, I am told, and he is quite at 
home and unembarrassed before the class. 
I incidentally learned that some of his 
pupils were offended and indignant at 
some of his moral allusions and intima- 
tions respecting their own tastes and 
habits while lecturing on the venereal dis- 
ease. As I entered the room after the lec- 
ture commenced, 1 did not hear the offen- 
sive expression; and from Dr. Gibson's 
high and commanding qualities, both as 
an operator and lecturer, I will not believe 
that he would mar those shining talents 
by the exhibition of the underworkings of 
an impure heart. In a medical man it is 
bad enough, in all conscience, to be sure 
that you discover in him the turbid work- 

10 Joseph Pancoast (1805-1882), educated at the 
University of Pennsylvania (M.D., 1828), was physi- 
cian to the Philadelphia Hospital, professor of 
surgery at Jefferson, from 1838 to 1847, and professor 
of anatomy from 1847 to 1874. 



ings of internal defilement But when a 
man of solid talents and high acquire- 
ments is understood to discover a relish for 
obscenity, and a desire to inflame rather 
than repress the headstrong promptings 
of young men, removed from the re- 
straints of mothers, sisters and acquaint- 
ances, and thrown loose upon the purlieus 
of a wide city, it becomes us to pronounce 
the whole a mistake. How improbable that 
Dr. Gibson, in Physick's own chair, ob- 
tained by dint of his own merit, and re- 
tained by general consent, and feeling a 
strong desire for the honorable career of 
his pupils, should so far mistake his policy 
and his duty in lecturing to the north and 
south, east and west, as to allow one breath 
of suspicion to fall upon the purity of his 
taste or the integrity of his intentions. 

As I have named three of these lectures 
in the Blockley Hospital, permit me to in- 
troduce for one moment the only remain- 
ing one, Dr. Dunglison, of the Jefferson 
Medical College. 11 There can be no mis- 
take in saying of Dr. Dunglison's medical 
pursuits, he is "totus in Mis." In addition 
to his private pupils and private practice, 
he promptly fulfils his hour four times a 
week in the College, and has the supervi- 
sion of half the Blockley Hospital, besides 
his weekly lecture there. These, with the 
common et ceteras of a city life, would keep 
a man tolerably busy. But, in addition to 
this, he writes more books, as your readers 
well know, than any monk with the world 
shut out could originate; books, too, that 
the medical world demand to be reprinted 
again and again. "Labor, ipse voluntas." 
It is evident, Mr. Editor, that while the 
rest of us are asleep, this man is wide 

"Robley Dunglison (1798-1869), born in England, 
studied medicine in Edinburgh, Paris, London and 
Erlangen, came to the United States at the invita- 
tion of Thomas Jefferson to teach medicine at the 
University of Virginia, later taught at the University 
of Maryland and, when North visited Philadelphia, 
was professor of the institutes of medicine at Jeffer- 
son. Dunglison's name was familiar to generations 
of medical students through the many popular 
books he wrote. 



304 



HAROLD J. ABRAHAMS AND WYNDHAM D. MILES 



awake at his nocturnal labors; and yet he 
has the personal appearance of a well- 
fed, easy, plump, care-shunning body. Pro- 
fessor Dunglison's lectures are delivered 
with rapidity and clearness of enunciation, 
and I need hardly say they are rich and 
instructive. 

It should be said, that, in addition to 
the Philadelphia Hospital, over the 
Schuylkill, just described, the original 
Pennsylvania Hospital yet remains in its 
excellence in the very heart of the city. So 
silent and clean and airy are its apart- 
ments, so urbane the officers and medical 
attendants, that I often felt constrained to 
loiter and seek retirement in the deep 
seclusion of its walls. Indeed, had I been 
taken sick in the city, I am almost certain 
I should have applied for one of its private 
apartments. It is scarcely possible for a 
public house to afford you equal comforts. 
The establishment occupies a whole 
square, and it is as still as a lodge in the 
wilderness. A change of medical officers 
occurred during my visits, and in addition 
to the requisite medical skill, these gentle- 
men, one and all, resident and consulting, 
manifested to me the most uniform kind- 
ness and urbanity. Capt. Marryatt and 
other Europeans have denominated the 
Blockley establishment the "beggar's pal- 
ace," and none who have seen it can deny 
the propriety of the cognomen. 12 But this 
old Hospital, with Penn's statue in bronze 
in the front yard, its tall ceilings, wide 
halls, ample library and apparatus, and 
all things so quiet and dignified, and even 
sylvan, is fit to be called the nobleman's 
nursery. Although the wards are not now 
very full, the mass having been consigned 
to Blockley, yet even now there is an in- 
teresting field for pathological research 
and observation. The same mode of visits 

12 Frederick Marryat (1792-1842), a captain in the 
British navy and a novelist, visited the United States 
in 1837-38 and published his impressions in A 
Diary in America, with Remarks on its Institutions 
(1839). 



and lectures exists here as at Blockley, this 
institution being the prototype; excepting 
that the clinical lectures are delivered here 
by the bed-side. 

Besides these two great institutions al- 
ready described, there are I know not how 
many private institutions, dispensaries and 
specialites. I visited several, and found 
them cooperating in the great business of 
medicine. In short, the business of teach- 
ing and lecturing seems to be the favorite 
employment of the profession. There may 
be twice as many out of the three Colleges 
giving lectures and instruction as within 
them. Some may do this simply for its 
emoluments, or from attachment to the 
business. Yet there are three rows of pro- 
fessional chairs in plain sight, any one of 
which would be a post of honor to the 
younger members of the profession. In this 
way the Colleges, although they are not 
limited to Philadelphia, have a corps of 
candidates under their daily observation. 

We see, then, that the foundations of 
medical science are deeply laid in this 
city, that its fame and emoluments are 
eagerly sought by men of commanding 
powers, and that their rewards are of no 
stinted character. For many years medicine 
must, in the nature of things, stand prom- 
inent in the City of Brotherly Love. She 
has disciples who toil over the midnight 
lamp through the love of their calling and 
a desire to see it exalted: from many such 
I have received, and beg to acknowledge, 
the cordial welcome and the liberal inter- 
change of professional opinion; and I ask 
permission, in conclusion, to say that, 
could many of my readers, who have been 
absent from schools and lectures many 
years, spend two or three weeks — nay, a 
winter — in a medical pilgrimage to Phila- 
delphia or other of our flourishing schools 
where clinical lectures could be attended, 
they would in my opinion find the sacrifice 
greatly to enhance their future respecta- 
bility and usefulness. 



Memoir of S. k 

1892- 

By FREDERICK C. 

SJERVIS BRINTON was born on 
September 2, 1892 and died on 
• September 19, 1969. He had four 
uncles who served in the Civil War as 
surgeons, one of them as Surgeon General 
in the Army of the Potomac. His father 
was an M.D. and encouraged his son to 
become a doctor. Jervis attended George 
School and then Swarthmore College for 
three years. He was graduated from the 
School of Medicine of the University of 
Pennsylvania in 1920, his course having 
been interrupted for a short term of serv- 
ice in the United States Artillery. 

In 1922 he married Edith Virden 
Ketcham of Chestnut Hill and there were 
two children, Jervis, Jr., and Ann Raab 
Brinton, and seven grandchildren. 

He began general practice in Ardmore, 
Pennsylvania, after two years as an intern 
in medicine and obstetrics. He then be- 
came Instructor in Medicine in the Uni- 
versity of Pennsylvania Graduate School 
and Attending Physician to the Bryn 
Mawr Hospital, where he later became 
consultant Physician. At various times he 

• Prepared and published at the request of the 
Council of The College of Physicians of Philadel- 
phia. 



fervis Brinton 
1969* 

SHARPLESS, m.d. 

was President of the Main Line Medical 
Society, Chairman of Medical Defense for 
Lower Merion Township, and a member 
of the Medical School Board, during which 
service he was instrumental in founding 
legislation for the compulsory vaccination 
of students against diphtheria. For these 
two latter services, he received medals. He 
was a member of The College of Physi- 
cians of Philadelphia, the American Medi- 
cal Association and the Merion Golf Club. 

Dr. Brinton's first wife died in 1954. In 
1956 he married Phillippa Queen of New 
York and Washington, D. C. In 1960 he 
underwent surgery by Dr. Michael E. De- 
Bakey, who replaced a large section of the 
aorta with a woven dacron tube. The op- 
eration was followed by serum hepatitis, a 
result of many blood transfusions, which 
endured for four years. After retirement, 
Dr. Brinton lived in Avalon, New Jersey, 
and Palm Beach, Florida, and attained 
prominence as a skillful golf putter. 

No account of him would be complete 
without mention of his pleasing personal- 
ity, his continuous good humor, and his 
capacity for friendship which endeared 
him to all who knew him. 



305 



Memoir of John Westgate Hope 
1914-1969* 

By C. EVERETT KOOP, m.d. 



JOHN WESTGATE HOPE died at the 
Hospital of the University of Pennsyl- 
vania on June 13, 1969, a victim of a 
disease around which much of his profes- 
sional life was centered. Few men have ever 
been as gifted as Dr. Hope in the manage- 
ment of grieving parents whose children 
faced inevitable death from cancer. 

Dr. Hope was born in Chicago, Illinois, 
on May 6, 1914, to Reginald and Dorcas 
Hope, who subsequently moved from 
( ;iii< ago to Coronado, California. 

Following graduation from Stanford 
University in 1936, Dr. Hope entered the 
Medical College of the same university 
and, after graduating therefrom, served 
residencies in pediatrics and in radiology- 
pathology at the Stanford Medical Center 
from 1940 to 1942. He then served in the 
United States Navy from 1942 to 1947, 
leaving the service with the rank of Lieu- 
tenant Commander. He came to Phila- 
delphia in 1947 to take further radiologic 
training under Eugene P. Pendergrass at 
the University of Pennsylvania School of 
Medicine and in 1951 became Radiologist- 
in-Chief to The Children's Hospital of 
Philadelphia. He had joined the faculty 
at the University in 1951 as Assistant Pro- 
fessor; from 1966 until his death he was 
Professor of Radiology in the University's 
School of Medicine. 

John Hope was thrust into the midst of 
a developing specialty in pediatrics and 
accepted the challenge as a pioneer en- 
gaged in finding new techniques in the 
examination and treatment of children by 

* Prepared and published at the request of the 
Council of The College of Physicians of Philadel- 
phia. 



radiologic means which have now become 
time-honored throughout the country. He 
had a remarkable ability for anecdotal 
teaching and as he unfolded the clinical 
history centering about the fdms he was 
about to demonstrate, the listener could 
capture a remarkable picture of a clinical 
entity radiographically proven and not 
soon to be forgotten. 

Although his teaching abilities took him 
many places in this country and abroad, 
John Hope became one of the stalwarts of 
the staff of The Children's Hospital where 
he was not only the father figure to many 
of the younger staff men but also an avail- 
able counselor to the families of the chron- 
ically ill children for whom his sympathy 
was always real and never assumed. 

Dr. Hope was a diplomate of the Ameri- 
can Board of Radiology and a member of 
the Radiological Society of North Amer- 
ica and of the American Roentgen Ray 
Society; a fellow of the American College 
of Radiology; a past president of the 
Society for Pediatric Radiology; and 
secretary of the Inter-Society Committee 
for the Registry of Radiologic Pathology 
of the Armed Forces Institute of Pathol- 
ogy. He served as consultant to the latter 
organization, as well as to Philadelphia 
General Hospital, Jeanes Hospital, U. S. 
Naval Hospital and the U. S. Veterans 
Administration Hospital, and Mercy- 
Douglass Hospital. He was a member of 
Phi Beta Kappa, Alpha Omega Alpha, 
Sigma Xi, the John Morgan Society, the 
Blockley Radiological Society, and hon- 
orary or affiliating member of a number of 
professional societies abroad. 

He is survived by his wife, the former 



306 



MEMOIR OF JOHN' 

Mary Crane, and by a son, William Aborn 
1 lope. 

Endearing himself to countless residents 
who rotated through The Children's Hos- 
pital for his unique teaching, he was held 



WESTGATE HOPE 307 

in high esteem. One group of retiring 
residents presented him with a plaque 
which expressed in pun form what many 
of us came to believe: "To Dr. John Hope, 
the greatest hope for little people." 



Memoir of David Warren Kramer 
i 890-1969* 



By HAROLD L. 

DAVID WARREN KRAMER, born 
November 15, 1890, in Philadel- 
phia was graduated from Jefferson 
Medical College in 1912. He interned at 
Philadelphia General Hospital. His sub- 
sequent medical career was largely devoted 
to these two institutions. 

After service in World War I in the 
Medical Corps of the British and United 
States Armies, Dr. Kramer was appointed 
Assistant Visiting Physician on the medi- 
cal service of his mentor, Dr. Solomon 
Solis-Cohen, at Philadelphia General Hos- 
pital. He became a chief in 1939 and an 
honorary consultant in 1956. Dr. Kramer 
served as President of the Medical Staff 
in 1952 and 1953. 

His two absorbing interests were diabe- 

• Prepared and published at the request of the 
Council of The College of Physicians of Philadel- 
phia. 



ISRAEL, m.d. 

tes and peripheral vascular disease. He 
organized the diabetes clinic at the Jewish 
Hospital and the vascular clinics at Phila- 
delphia General and Jefferson Hospital. 

Dr. Kramer was on the faculty of Jeffer- 
son Medical College and became Associate 
Professor of Medicine in 1948. In 1962 he 
was honored by the Delaware Valley Dia- 
betes Association, receiving the J. Howard 
Reber Memorial Medal. Author of more 
than 50 papers on diabetes and vascular 
disease, he served on the editorial board of 
Angiology. 

His personal life was repeatedly marred 
by tragedy: his first wife died in childbirth, 
his only child died of breast cancer, and 
his second wife died after prolonged ill- 
ness. 

Dr. Kramer continued his practice at 
2007 Pine Street until shortly before his 
death in Jefferson Hospital on May 13, 

1969. 



308 



Memoir of Eu£ 
1903- 

By ORAM R. 

EUGENE A. MEYER, M.D., was 
born on August 30, 1903 in Phila- 
delphia, Pennsylvania. His father, 
Eugene E. Meyer, a native of Frankford, 
Germany, came to the United States in his 
late teens. Dr. Meyer's family later moved 
to New Jersey and he attended the Pal- 
myra High School, where in addition to 
being a satisfactory student he was a popu- 
lar football quarterback. 

He received a B.S. degree from Hahne- 
mann College of Science in 1923 and an 
M.D. degree from Hahnemann Medical 
College in 1927. After graduation he 
married Ida Hafner, served an internship 
for one year at West Jersey Hospital and 
then started general practice in Moores- 
town, New Jersey. Soon after starting 
practice, he began work in otolaryngology 
which he assiduously pursued and which 
enabled him to become certified by the 
American Board of Otolaryngology in 
1936. In June 1942 he entered the United 

* Prepared and published at the request of the 
Council of The College of Physicians of Philadel- 
phia. 



;ene A. Meyer 
1969* 

KLINE, m.d. 

States Army as a Major and was honora- 
bly discharged in March 1946. 

He was chief of the Ear, Nose and 
Throat Department of West Jersey Hos- 
pital for thirty years until illness forced 
his retirement. He was a member of the 
following professional societies: The 
American Academy of Ophthalmology 
and Otolaryngology, the American Medi- 
cal Association, West Jersey Medical Soci- 
ety, Camden County Medical Society and 
The College of Physicians of Philadelphia. 

Golf was his favorite sport and he ex- 
celled in this as he did in most things he 
attempted, being golf champion of the 
River ton Country Club at one time. He 
also had other interests that demonstrated 
his versatility. His beautiful naturalistic 
garden contained many rare and unusual 
wild flowers. He was prominent in socie- 
ties for preservation of American wild 
life and natural resources. He also was in- 
terested in music and literature. 

Dr. Meyer died August 7, 1969. He is 
survived by his wife and three children, 
Betty, Eugene A., Jr., and Mrs. Joan M. 
Jackson. They all reside in Medford Lakes, 
New Jersey. 



309 



Memoir of George Gordon Snyder, Jr. 
1908-1969* 

By THOMAS F. FURLONG, JR., m.d. 



BORN on September 30, 1908, at 
Rosemont, Pennsylvania, the son of 
George Gordon Snyder, Sr., and 
Elizabeth Anderson, G. Gordon Snyder, 
Jr., received his undergraduate education 
at Villanova University and his medical 
training at Temple University School of 
Medicine. He served his internship at 
Bryn Mawr Hospital and took post-gradu- 
ate training at the University of Pennsyl- 
vania Graduate School of Medicine, Lem- 
pert Institute of Otology in New York 
City, and Columbia University Medical 
Center. 

Dr. Snyder was appointed to the Attend- 
ing Staff of Bryn Mawr Hospital in 1936. 
He served as Assistant Otolaryngologist 
from 1936 to 1938 and as Assistant Attend- 
ing Otolaryngologist from 1938 to 1954. 
He was appointed Chief of the Otolaryn- 
gology Service, Department of Surgery, in 
1954 and held that position until his sud- 
den death on March 21, 1969. Dr. Snyder 
served on many committees of the Medical 
Staff, including the Executive Committee. 
The affection of his colleagues and their 
respect for his skill in his specialty was ex- 
pressed by their action in electing him 
Vice President of the staff in 1965. 

Dr. Snyder was also associated with 
Misericordia Hospital as Associate Attend- 
ing Physician in Otolaryngology. He was 
a member of the Courtesy Staff in Oto- 
laryngology at Paoli Memorial Hospital. 
He was Assistant Professor of Otolaryn- 
gology at Temple University Medical Cen- 
ter. 

Doctor Snyder was a member of many 

* Prepared and published at the request of the 
Council of The College of Physicians of Philadel- 
phia. 



medical societies, including the American 
Medical Association, Montgomery County 
Medical Society, Pennsylvania Medical 
Society, the American Academy of Oph- 
thalmology and Otolaryngology, the Penn- 
sylvania Academy of Ophthalmology and 
Otolaryngology, The College of Physicians 
of Philadelphia, Philadelphia Laryngologi- 
cal Society, the Pan-American Medical As- 
sociation, the Pan-Pacific Surgical Society, 
the American Society of Facial Plastic 
Surgery, the American College of Sur- 
geons, the International College of Sur- 
geons, the American Laryngological, 
Rhinological and Otological Society, and 
the Royal Society of Medicine, London. 

Dr. Snyder was devoted to his profession 
and the welfare of his patients. He took 
great pride in his work, striving constantly 
to improve himself with post-graduate 
studies. His surgical technique was un- 
doubtedly that of a master. 

It was my privilege to know Gordon 
Snyder both as a next door neighbor and 
as a professional colleague for many years. 
He was a devoted family man and is sur- 
vived by his wife, the former Lillian 
Graham, a daughter, Jacqueline, and a son, 
Dr. G. Gordon Snyder, 3rd, now in his 
fifth year of studies in otolaryngology in 
New York. Dr. Snyder was extremely 
proud that his son was to follow in his 
footsteps in otolaryngology. 

Gordon will be remembered with great 
affection. His good humor, quick wit and 
gaiety made him extremely popular and 
almost belied his great compassion for 
those in need. We all lost a great friend, 
one whose life was truly dedicated to 
otorhinolaryngology. 



310 



President's Address: 
The College of Physicians of Phildelphia 

By FRANCIS C. WOOD, M.D. 



The bylaws of the College state that — 
among the duties of the president — he 
shall deliver an annual address at the 
meeting in January. 

I have kept the Fellows informed 
throughout the year by my letters, telling 
of our activities, so I will not need to say 
much tonight. 

I want to mention only a few outstand- 
ing items in our progress during the past 
year. 

1. Our administration is in good trim, 
under the wise and kindly guidance of 
our Executive Director, Dr. W. Wallace 
Dyer. The enjoyment of being President 
is dependent primarily on the fact that 
you no longer have to keep everything in 
mind or in order, nor do you have to 
have any imagination or good ideas. Dr. 
Dyer and his staff have done all of this 
to perfection. 

Chairman Clarence Francis of General 
Foods gave a talk at the Convention of 
the National Association of Manufacturers 
some years ago in which he said: 
"You can buy a man's time, you can 
buy a man's physical presence at a given 
place; you can even buy a measured 
number of skilled muscular motions per 
hour or day. 

"But you cannot buy enthusiasm; you 
cannot buy initiative, you cannot buy 
loyalty; you cannot buy devotion of 

• Annual Report of the President, The College 
of Physicians of Philadelphia, 7 January 1970. 



hearts, minds and souls. You have to 
earn these things." 

Wallace Dyer and Elliott Morse have 
earned this loyalty from our staff. 

2. Dr. Dyer has set up our financial af- 
fairs with the assistance of Mr. Dennis 
Dougherty, so that we know where we 
stand, and we are living within our in- 
come. 

3. He has presided over the improve- 
ment of the appearance and function of 
this beautiful building. 

Shortly, we will be facing some impor- 
tant decisions. Dr. George Berry's Visit- 
ing Committee to the Library will make 
its report. Then an Internal Committee of 
the College will review the recommenda- 
tions and make plans for the future. With 
this sort of thinking as a foundation for our 
planning, we should be able to go into ac- 
tion and accomplish our purposes. 

It really has been a lovely experience 
being president. It has been exciting, en- 
joyable and fun from beginning to end. 

I thank you for this indication of your 
affection, and I am glad I will be able to 
hand the gavel at the end of this meet- 
ing to a man whose heart and soul is in this 
College, and has been for years, ever since 
he revitalized our S. Weir Mitchell Fel- 
lowship program; and who, as Vice Pres- 
ident and Chairman of our Finance Com- 
mittee, has contributed his time, his 
knowledge and a great deal of thought 
and work to our affairs, Dr. George I. 
Blumstein. 



311 



Report of the Secretary for the Year^Ended 
December 31, 1969 



Attendance 

300 
175 



Stated Scientific Meetings: 

January The Eightieth Thomas Dent Mutter Lecture 

Ernest E. Aegerter, m.d. 

March The Ninety-fifth Mary Scott Newbold Lecture (Sympo- 

sium III). A Community Health Forum on "Popula- 
tion Avalanche". Moderator: Luigi Mastroianni, Jr., 
m.d. Panel: Benjamin Viel, m.d., Alan Guttmacher, 
m.d., Bernard Berelson, ph.d. 

May The Eighth Hira S. Chouke' Lecture 208 

Elliott Middleton, Jr., m.d. 

October The Ninety -sixth Mary Scott Newbold Lecture 543 

Ralph Nader 

November The Forty-eighth James M. Anders Lecture 225 

Joseph T. English, m.d. 
December The Twenty-eighth Alvarenga Lecture 512 

Colin S. Pittendrigh, ph.d. 

December The Thirteenth Arthur Parker Hitchens Lecture 

(Held at Philadelphia County Medical Society) 

Joseph H. Boutwell, ph.d., m.d. ' 

Total Ballot 

Regular Business Meetings: 

January 8, 1969 319 

May 14, 1969 303 

October 1, 1969 No balloting 

November 5, 1969 341 

December 3, 1969 245 

M embership 

Sections of the College: 

Ophthalmology 77 

Otolaryngology 38 & 3 Hon- 

orary & 3 
Dues Re- 
mitted 

Public Health, Preventive and Industrial Medicine 30 

Medical Historv (Fellows and Friends of the Section) 120 



312 



RETORT OF THE SECRETARY 



313 



Membership : 

Honorary 

Hod. 

Fellow Non-Res. Assoc. Foreign U.S.A. Assoc. Total 

December 31, 1968 1,146 163 15 4 1,319 

Died during year 24 3 27 

Resigned 6 3 9 

Elected 44 3 47 

Re-Instated 2 2 

Transfer from Resident 

to Non-Res (-13) (+13) 

Forfeited 3 1 4 



December 31, 1969 1,146 172 15 4 1,328 



Life Membership 
New Type 

Under 70 25 9 

Over 70 13 3 

Old Type (Commuta- 
tion dues) 6 

44 12 



Dues Remitted as of 

December 3 1, 1969. 41 14 



Annual Contributors as of 

December 31, 1969. 1,061 136 

John L. McClenahan, m.d. 

Secretary 



Report of the Treasurer for the Year Ended 

June 30, 1969 

General Fund 



Income 

College general income $201 ,712 

Library 71,063 I 

Medical Documentation Service 77,850 

Gifts 32,201 j 

Indirect expense allowance on grants 56,214 

Total unrestricted income 439,040 



Expense 

Hall Committee 74,332 ! 

Library 196,200 j 

Medical Documentation Service 76,833 

College Collections 8,767 I 

Publications 10,267 ; 

Secretary -Treasurer's office 35,047 

Executive Director's office 28,615 

Entertainment Committee 2,578 

Employee benefits 24,971 1 

Direct grant expense 173,953 I 

American Philosophical Society grant 3,441 , 

College general expense 13, 692 

Total expense 648,6% ( 

Less: 

Charges to restricted endowment income (62,328) 

Charges to Special Funds (43, 160) 

Reimbursement of direct expenses of grants (173, 953 ) 

General fund expense 369 , 255 

Net income for the year ended June 30, 1969 $ 69,785* 



* Most of this apparent large net balance is a non-recurrent one due to two major factors: (1) a change 
in the accounting system from a cash to an accrual basis which incorporated certain funds that were not 
earned in this year; (2) defraying certain operating costs from the Development Fund (gifts from foundations). 
More complete details of the audit are available to the Fellows in the office of the Executive Director. The 
audit was conducted by Main Lafrentz and Co. 

Kendall A. Elsom, m.d. 

Treasurer 



314 



Annual Report of the Committee on the Library 



REGIONAL YEAR. The calendar 
year is the report year of the College Li- 
brary. During 1969, the first year of Re- 
gional Medical Library operation was 
completed on May 30, 1969, and the 02 
regional year began on June 1. Regional 
affairs overshadowed regular College Li- 
brary activity as new programs were 
launched and relationships with the Na- 
tional Library of Medicine and within the 
region were proposed, tested, reexamined, 
and frequently restructured. New mem- 
bers were added to both Regional and 
College staffs; temporary space arrange- 
ments proved inadequate; relations with 
the community changed as free services 
were expanded; and incredibly large 
chunks of time were devoted to inter- 
viewing, procedural changes, report prep- 
aration, committee meetings, grant and 
supplementary grant applications, and 
myriad other giant administration activi- 
ties unforeseen and unimagined. The 
brevity of this Annual Report on the Col- 
lege Library reflects not less activity but 
rather less time for introspection. 

GROWTH. The staff devoting full time 
to regional library activity grew from eight 
in January 1969 to eleven one year later. 
The Regional Photocopy and Teletype Sec- 
tion outgrew its original study room with 
one photocopy machine and moved to the 
south end of the remodeled library work- 
room with two machines and shared ac- 
cess to a third. The Library's Medical 
Documentation Service promptly moved 
into the vacated study room and agreed 
to be responsible for operation of the tele- 
type portion of the regional program. In 
this period the monthly level of photo- 
copies supplied in lieu of interlibrary loan 
rose from 1,500 to 2,600 and hit a pre-holi- 
day peak of 3,500 articles in November. 

•January 1-December 31, 1969. 



Another gauge of the growth of library 
service is the annual "Ten or More" report, 
which shows that the number of loans 
(including photocopy) supplied to libraries 
which borrowed ten or more items during 
the year rose from 47,070 in 1968 to 52,357. 
If this figure were to include all loans, it 
would be 56,282 and even this would not 
include articles photocopied on a fee basis 
for non-qualifying institutions and individ- 
uals not eligible for free service in 1969. 

The use of reference services also in- 
creased but at a modest enough rate to 
suggest a need for more publicity. MED- 
LARS search formulation service was first 
offered in August 1969. 

CHANGE. The grant-supported re- 
gional medical library service produced 
many new services as well as the expan- 
sion of established ones. It effected changes 
in the College Library's relationships to 
the community and to the Federal govern- 
ment. The return of the Library's first 
MEDLARS trainee from Bethesda in Aug- 
ust followed by the second in December, 
the installation of a key punch machine 
and the employment of an operator necessi- 
tated the conversion of the third floor lunch 
room into MEDLARS office space and the 
conversion of the basement kitchen area 
into a dining facility. 

GROWING PAINS. The euphoric in- 
troduction to last year's report has given 
way to a realistic acceptance of the frus- 
trations of trying to please more people. 
For a less formally structured institution 
there were painful adjustments in becom- 
ing a partner of the Federal government 
to meet detailed reporting requirements 
and stringent fiscal regulations despite 
the fact that new and better techniques 
sometimes resulted. Services graciously of- 
fered and gratefully received acquired a 



315 



316 



ANNUAL REPORT ON THE LIBRARY 



slightly different flavor when cast in the 
mold of obligation and right. 

Aspects of the program which sparked 
more irritation than inspiration are: 
budgetary limitations and inflexibilities; 
inability to carry over funds remaining at 
the end of the 01 budget year; complexity 
of procedure and length of time required 
to apply for supplementary funds; impact 
of the policy change by the National Li- 
brary of Medicine requiring "equalized 
access" to commercial and nonprofit in- 
stitutions; delay in reimbursement of funds 
expended by the College; space limita- 
tions of a 60-year-old building; fre- 
quency of change in the personnel of the 
Extramural Program section of the Na- 
tional Library of Medicine; delicacy of 
finding a balance between the need to 
accord the Regional Medical Library Com- 
mittee something more than a strictly ad- 
visory role and the apprehension of the Li- 
brary Committee (and some Fellows) of 
the College over diminution of control of 
the College Library; delay in approval 
of a regional newsletter by the College 
Library Committee (now endorsed); re- 
modelling costs in excess of budgetary 
limitations; delay in the completing of the 
Visiting Survey Committee report; lack of 
opportunity to coordinate plans with pro- 
grams initiated by the Susquehanna Valley 
and Western Pennsylvania Regional Med- 
ical Programs leading to overlapping train- 
ing efforts; failure to secure American 
Hospital Association survey results from 
two of the three hospital associations in 
the Mid-Eastern region; weaknesses of 
some local hospital libraries in relation to 
the research programs undertaken by hos- 
pital administrations; internecine differ- 
ences, remarkable not for their intensity 
but because they weren't apparent before 
the grant; weakening of the program as 
budgetary limitations required abandon- 
ment of hopes for a deputy director, a 
regional communications agent, TWX in- 
stallations in libraries which might per- 



form a subregional function; audiovisual 
program, and messenger service; postpone- 
ment of solicitation of Regional Medical 
Program cooperation in identification of 
unaffiliated users; failure to stimulate 
greater R.M.P. participation; the general 
environment of fiscal uncertainty stemming 
from intimations of Federal budget cuts; 
executive branch of the government threats 
to withhold funds even if appropriated: 
and indications of orders of priorities 
within H.E.W. and N.L.M.; limitations of 
time resulting in priority for response to 
irritations rather than to creative initia- 
tive; and finally difficulties in recruiting 
attributable to one or more of the factors 
noted above. 

SUB-REGION ALIZA TION. Discussion 
of institutional and geographic sub-re- 
gionalization by the Librarian of the 
College as early as January 1967 pre- 
sented minus and plus factors. Direct serv- 
ice from the College Library to hospitals 
fostered good will through the years and 
provided the College with a community 
service image which nurtured institutional 
survival and engendered community fiscal 
support. Displacement of this direct flow 
through the channel of the hospital's med- 
ical school affiliation would be logical from 
a community planning viewpoint. It would 
allow the medical school libraries to assess 
the weaknesses of collections which are 
vital to the training of students, interns, 
and residents who are the medical schools' 
educational responsibility. In many cases 
it could encourage long-overdue strengthen- 
ing of neglected collections previously lack- 
ing a voice strong enough to command at- 
tention. The increased time to process re- 
quests for material not available from 
medical school libraries which are referred 
to the College Library must be mini- 
mized. Indirect use will relieve the regional 
library of traffic to supply copies from 
common journals and may offset the 
inconvenience of charges which some 
schools will have to levy in contrast to the 



ANNUAL REPORT ON THE LIBRARY 



317 



free service available from the grant-sup- 
ported regional library program. 

SERVICE TO FELLOWS. Some Fellows 
realize that they receive free photocopy 
from the College through the medical 
school or hospital library with which they 
are associated but that they would pay 
for this service provided directly from the 
College. They are satisfied with the ex- 
planation that grant support doesn't sub- 
sidize College service to its Fellows but in- 
creases the availability of library resources 
to Fellows and others through the institu- 
tions with which they are affiliated. In al- 
most all cases it is more convenient to have 
copies delivered where they work or teach. 
To accommodate occasional direct use of 
their Library by Fellows, Council approved 
distribution of ten coupons, each of which 
entitles the Fellow to free photoduplica- 
tion of one journal article. This privilege 
is College-supported; it is not grant-funded. 

MEDLARS search formulations are 
available to Fellows directly from the Col- 
lege or through a more convenient insti- 
tutional affiliation. In many cases it is de- 
sirable to establish direct contact between 
the original questioner and the librarian 
who plans the search strategy to define 
the search in vocabulary terms in the 
MeSH (medical subject heading) list or 
thesaurus. MEDLARS search specialists 
are also available to groups of Fellows and 
other interested persons for MEDLARS 
user orientation programs. 

"EQUALIZED ACCESS." The most 
traumatic experience of the year was the 
decision of the National Library of Med- 
icine in August to require immediate 
compliance with a directive to provide 
free photocopy to commercial as well as to 
non-profit educational institutions. This 
was distressing because federal authorities 
had frequently expressed their determina- 
tion not to supplant hard local money 
with soft federal funds. Since there was 
no guarantee (or really even hope) of 
extra funds to cover this additional free 



load, the new policy has the effect of les- 
sening service to hospitals and medical 
schools to provide free service to profit- 
making agencies. 

For the College this precipitous policy 
reversal threatened a considerable source 
of financial support from fees paid by 
pharmaceutical firms and others who value 
fast service and recognize equity of sharing 
the costs of acquisition, processing, stor- 
age, and servicing of the materials to be 
copied. These corporate friends usually 
voluntarily augment the minimal regis- 
tration fee for borrowing and photodu- 
plication privileges. The new policy reduces 
the motivation for this help but not 
the need for it. 

Ironically, pressure for this free service 
did not come from within the Mid-East- 
ern region but from another section of the 
country where the relationship between 
the private resource library and local in- 
dustry was not so cordial. Although the 
length of time given to comply with the 
new policy was extended and each regional 
medical library was permitted to recom- 
mend its own methods of insuring "equal- 
ized access," the development of a suitable 
procedure was a major drain on regional 
personnel and the implementation of new 
procedures was confusing to library staff 
and users alike. 

QUOTA SYSTEM. The Mid-Eastern 
Regional Medical Library Service re- 
sponded to the new situation by initiating 
a quota system which fairly distributes as 
much free service as federal funding will 
support. Questionnaires were sent to all 
institutional users to determine the num- 
ber of qualified users (biomedical person- 
nel engaged in professional education, 
service, or research) served through each. 
In consultation with pharmaceutical com- 
pany librarians, it was agreed that senior 
research personnel constitutes a qualified 
user group. A conference with officers of 
the National Library of Medicine resulted 
in extra weighting of research personnel. 



318 ANNUAL REPORT 

The resulting quota determination formula 
protected the College Library from bank- 
ruptcy and encouraged decentralized bor- 
rowing by libraries wishing to husband 
their quota. 

Red quota stamps were distributed to 
477 institutions (266 hospitals, 211 others) 
for stapling on interlibrary loan request 
forms. Over-the-quota requests will be 
filled on a charge basis. The alternative of 
an embargo list of common titles was con- 
sidered but rejected to avoid hurting new 
fledgling libraries without formal affilia- 
tions. The quota plan was approved by the 
College Library Committee and the Mid- 
Eastern Regional Medical Library Com- 
mittee. For our statistically minded read- 
ers and to make it a matter of record, the 
MERML quota model for the first half 
of 1970 follows: 

/p + r s + 2r S \ 

\P + R S + 2RS/ ^ 

Where p = total health science popula- 
tion in one institution 
r = total health science research 
population in one institu- 
tion 

s = total health science seniors 
(Ph.D., M.D., etc.) 
rs = total health science research 
seniors 

and where 

P = total health science population 

in region (survey responders) 
R = total health science research 

population in region 
S = total health science seniors 
population in region 
RS = total health science research 
seniors in region 

V = volume of loans supported by 

grant (adjusted for non-use) 

V = 100,000 

P = 116,471 S 42,554 

R = 7,729 RS 2,472 

P + R = 124,200 S + 2RS 47,498 



ON THE LIBRARY 

The equation is intended to predict the 
interlibrary loan generating potential of 
each institution. 

GOLD STAMPS. In addition to the 
red regional stamps issued according to the 
principle described above, gold stamps 
were issued to institutions which make fi- 
nancial contributions to the College Li- 
brary and are ineligible for a regional quota 
or whose regional quota is below the equiv- 
alent value of their support. A minimum 
contribution of $50.00 entitles institutional 
registrants to borrow 75 volumes per year. 
Gold stamps are not valid for photoduplica- 
tions. They may only be used to borrow 
original material. 

ACCOMPLISHMENTS. The following 
statistics are offered in continuation of 
data recorded in last year's report. 

Regional Photocopy and TWX Section. 
The rate of growth of demand is shown by 
the first table below. 



1968 


Requests 
received 


College 
filled 


Referred 
elsewhere 


Re- 
jected 


Re- 
turned 
unfilled 


Not 
re- 
corded 


Jan.- 


10,439 


8,975 


826 




617 


21 


June 
July- 
Dec. 


12,120 


10,306 


1,094 


461 


258 


1 


1969 














Jan- 


16,461 


13,904 


1,663 


515 


380 


1 


June 
July- 
Dec. 


31,522 


27,697 


2,068 


563 


1,194 






I 



A comparison of figures for the July to 
December period in 1968 with the same 
period in 1969 reveals that the College's 
fill rate improved despite an increase of 
more than double the number of requests 
received. This improvement by 1.1% is 
remarkable when the rate is so close to 
90%. Less felicitous is the observation 
that the College Library was unable to 
refer as large a portion of unfilled requests 



ANNUAL REPORT ON THE LIBRARY 



319 



elsewhere in the region and the not sur- 
prising result was that the percentage of 
unfilled requests rose from 2.2% to 3.8%. 

These changes and the increase in speed 
in filling requests, noted below, are attrib- 
utable to the inclusion of loans of originals 
as well as provision of photocopies begin- 
ning in July 1969. 



Requests received 
Requests rejected 
Filled by College 
Referred elsewhere 

a. within region 

b. to other regions 

c. to N.L.M. 
Not recorded 
Returned unfilled 



July-Dec. 
1968 

12,120 

3.8% 
88.4% 

7.9% 

• 1% 
1.5% 

• 1% 
2.2% 



July-Dec. 
1969 

31,552 



89.5% 

5.0% 
• 1% 
1.6% 

3.8% 



Another way of assessing performance is 
to examine the time required to process 
requests during the same two six-month 
periods. The improvement here is so dra- 
matic that some explanation must be 
sought. The most plausible one is the trans- 
fer of this operation into less crowded space 
in the Library Workroom and the upgrad- 
ing of equipment by the installation of 
two Xerox 720 machines. The increasing 
competence of an already efficient staff 
cannot be discounted. 



Filled on day of receipt 
Filled in one working day 
Filled in two working days 
Filled in three working days 
Filled in 4—5 working days 
Filled in 6-10 working days 



July-Dec. 
1968 

4.5% 
64.4% 
30.1% 

1.0% 

• 1% 

• 1% 



July-Dec. 
1969 



7.9% 



• 1% 
•1% 



Service area. It has been noted on sev- 
eral occasions that the overwhelming por- 
tion of utilization of the Mid-Eastern Re- 
gional Medical Library Service is by li- 
braries from the five counties in the south- 
east corner of the state of Pennsylvania. 
It is gratifying to be able to demonstrate 
a modest trend toward more widespread 
utilization. This is seen more clearly when 
the number of institutions is considered 



than when the number of loans is tabu- 
lated. Small gains in New Jersey and no 
gains in Delaware prove that greater 
publicity efforts are needed. 



1967 



1969 



No. of 
loans 

Metropolitan Phila. 36,688 

(5-county area) 
Pennsylvania, other 1,466 
New Jersey, southern 1,182 
Delaware 378 
Outside of region 726 



% 
90.5 

3.6 
2.9 
.9 
1.8 



No. of 
loans 

45,058 



4,004 
2,211 

423 
661 



% 
86.0 

7.6 
4.2 
.8 
1.3 



40,440 99.7 52,357 99.9 



1967 



1969 



Metropolitan Phila. 

(5-county area) 
Pennsylvania, other 
New Jersey, southern 
Delaware 
Outside of region 



No. 

of or 

librar- /o 
ies 

87 68.0 



No. 
of 
librar- 
ies 



87 51.4 



13 
7 
6 

15 



10.2 
5.5 
4.7 

11.7 



45 
15 
6 
16 



26.6 
8.9 
3.6 
9.5 



128 100.1 



169 100.0 



The figures in the table immediately 
above do not represent the total bor- 
rowing traffic, but only those institutions 
which borrowed ten or more items during 
calendar years 1967 and 1969. 

Reference services. Regional budget 
planning and reporting consider reference 
services in two categories, MEDLARS serv- 
ices and traditional reference services. 
Because MEDLARS search formulations 
were not begun until August 1969 there 
are no comparable statistics for 1968. Tra- 
ditional reference services predated re- 
gional funding but data gathering tech- 
niques have changed enough to preclude 
completely valid comparisons. 

To provide a partial baseline for future 
perspective, we can say that 148 MEDLARS 
searches were formulated during 1969 and 
that of these 1 39 were received directly from 
users; 28 were referred from the National 
Library of Medicine. 



320 



ANNUAL REPORT ON THE LIBRARY 



During the 1968-69 regional year re- 
cords were kept of 47 Non-MEDLARS 
searches and 380 quick reference questions 
as well as the compilation of 26 bibliog- 
raphies. 

The following tabulation covers the 
period July to December 1969 and is in 
the format requested by the National 
Library of Medicine. 



Non-MEDLARS Searches 

a. Quick reference questions 5,242 

b. Medium to long questions 433 

c. Citation verifications 201 

d. Reference searches 25 



Total non-MEDLARS searches 5,901 
Bibliographies produced 24 



Within this section of the report it is 
appropriate to relate the holding of a 
MEDLARS user orientation program at 
the College on September 25, 1969 which 
was well-attended and enthusiastically re- 
ceived. Subsequent sessions were held at 
Temple University School of Medicine and 
at University of Pittsburgh School of Medi- 
cine. 

EVALUATION SECTION. Impor- 
tant contributions of the Evaluation (Pro- 
gram Analysis) Section of the Regional 
Library Service are conspicuous in the text 
and statistical tables presented above. The 
solid work of Miss Carol C. Spencer, Head 
of the Evaluation Section, is evident in 
the data derived from the "Ten or More" 
report, in the development of the MERML 
quota formula, in the analysis of data 
relating to the provision of photocopy in 
lieu of interlibrary loan, and in the study 
of use of MERML services by geographical 
area. 

A follow-up study was made for com- 
parison with last year's tabulation of "Pre- 
Regional Interlibrary Loan Patterns" but 
the pressure of quota implementation has 
delayed its analysis. Another study not yet 
reported in full was a solicitation of in- 
stitutional users' opinions about additional 



or strengthened services which they would 
like from the regional library. 

The final report on the contract with 
the Institute for Advancement of Medical 
Communication to design a data collec- 
tion and analysis system was received on 
July 1, 1969. This system will serve to con- 
tinuously monitor the quality and cost of 
the interlibrary loan service, to compile 
statistics required for quarterly and annual 
reports to N.L.M. and to assess the impact 
of the College's interlibrary loan service 
on the region's libraries and their needs 
for additional services. The practicality 
of a sampling technique was demonstrated 
which will permit a 1 to 20 sampling ratio 
to satisfy the practical difference criterion 
for acceptable reliability of a maximum 
sampling error not to exceed ±5% at 95% 
confidence. This technique has been ac- 
cepted by the National Library of Medicine 
for parts of the regional medical library 
reports. 

In order to acquire and analyze cost 
data on interlibrary loans, a small Random 
Alarm Mechanism (RAM) was carried by 
each staff member handling interlibrary 
loans. When the RAM buzzed, the in- 
dividual recorded what he was doing at 
that moment by checking the appropriate 
category on a short checklist. These check- 
lists of mutually exclusive categories of 
activities were tailored for each depart- 
ment involved in interlibrary loan opera- 
tions. The valid serial data on unit costs 
which were derived provide a basis for 
decisions regarding alternative ways of 
organizing service and for assessing deci- 
sions once they are implemented. 

UNION LIST OF MEDICAL SERIALS. 
Programs were purchased from the Med- 
ical Library Center of New York (MLC) 
for the production of such lists as: journals 
currently received by the College of Phy- 
sicians of Philadelphia; journals currently 
received by libraries now included in 
"JIM List, 1968, Guide to Journals listed 
in Index Medicus with their Pennsylvania 



ANNUAL REPORT ON THE LIBRARY 



321 



Locations"; titles and holdings of journals 
currently received by the College to be 
augmented later by the addition of other 
libraries significant because of their size or 
subject strength. 

A file of cards has been produced from 
the MLC tapes and cards for titles cur- 
rently received by the College have been 
extracted from this file. Cards have been 
prepared for titles received by the College 
but not in the MLC store; a merged tape 
has been prepared for a list of titles cur- 
rently recevied by the College. College 
of Physicians of Philadelphia holdings of 
these titles have been added to the cards 
preparatory to input for inclusion on the 
merged tape. It is hoped that the print- 
out of the first products of the system will 
be available in published form by June 
1970. 

"NEWSLETTERS." Pending approval 
of a more formal newsletter, the Regional 
Library Service issued two Interim Com- 
munications, no. 1, May/June 1969 and 
no. 2, August 1969. The Temple Univer- 
sity School of Medicine Library generously 
agreed to compile and print the first 
MERMLS newsletter which appeared after 
the end of this report year. 

MINI-LIBRARY. The books in the 
Postgraduate Medical Institute Library 
(New England Journal of Medicine, 280: 
474-480, February 27, 1969) have been 
assembled for display and loan. The li- 
brary was displayed at a Hospital Library 
Conference at Harrisburg on October 23, 
1969 and at a meeting of the Philadelphia 
Regional Group of the Medical Library 
Association held at Temple University 
School of Medicine in November. It was 
loaned to the Ephrata Hospital on a dem- 
onstration basis. Mrs. Michele Winters, 
the Regional Reference Librarian, adapted 
inventory and evaluation report forms 
as well as posters for use with the library. 
She also obtained carrying cases suitable 
for transportation of the library. In this 
activity she drew upon experience with 



deposit collections placed in branches of 
the Free Library of Philadelphia. 

MID-EASTERN REGIONAL MED- 
CAL LIBRARY COMMITTEE. There 
were four meetings of the Committee dur- 
ing 1969. Members of the Regional Plan- 
ning Council were invited to attend the 
meetings. 

At the meeting on March 6, a progress 
report was made on the work of the Visit- 
ing Survey Committee appointed by the 
President of the College to examine the 
resources and services of the College in 
terms of present and future function, ade- 
quacy of building, staff, administration, 
collection, service policies, book preserva- 
tion, budget, and community relations. 
Preliminary investigations reviewed salary 
scale, sources of financial support, mech- 
anization, messenger service, and public- 
ity. The Committee (Regional) discussed 
the merits of direct and indirect service to 
hospital libraries. Miss Spencer reported 
that indirect access might permit medical 
school libraries to supply about 13,000 re- 
quests per year with about 2,100 referred 
to the College Library for ultimate proc- 
essing. This assumes that the medical 
school libraries can supply 85% of the 
hospitals' needs. A subcommittee on inter- 
library loan under the chairmanship of 
Robert Lentz was appointed to review 
the possibilities. The Regional Committee 
agreed to ask all medical libraries in the 
region to report interlibrary loan trans- 
actions for survey purposes. Specific in- 
formation about the number of loans re- 
quested and received from each lender and 
the number of loans to each borrower is 
needed. 

The Subcommittee on Interlibrary Loan 
consisting of Robert Lentz, Chairman, 
Ida Draeger, Helen Lake, Jess Martin, 
and Jerome Rauch met on April 8 and pre- 
pared a report proposing that: 1., all interli- 
brary loan requests from affiliated hospitals 
be routed through the library of the medi- 
cal school with which they have affiliation; 



322 ANNUAL REPORT 

2., the medical school library, if it has the 
recjuested material, will service the request 
on a fee-for-service basis at the library's es- 
tablished rate of charge; 3., requests for 
material not available at the medical school 
library will be forwarded to the Mid-East- 
ern Regional Medical Library for free 
photocopy to be sent directly to the affili- 
ated hospital library. 

This subcommittee report was received 
and considered at a meeting of the Re- 
gional Medical Library Committee held on 
April 10. There was a considerable lack 
of agreement concerning ways of imple- 
menting the recommendation. Several med- 
ical school librarians agreed to establish 
experimental arrangements with one or 
more affiliated hospitals to determine the 
feasibility of sub-regionalization. 

The next meeting of the Regional Med- 
ical Library Committee was held on Sep- 
tember 18. The Regional Medical Li- 
brary staff presented summary reports of 
the first year (July 1968 to June 1969) of 
operation. Elliott Morse reported that it 
was unlikely that grant funding would 
permit any expansion of regional library 
services in the coming year. The Regional 
Medical Library Committee approved in 
principle the proposal to establish quotas 
for free regional interlibrary loan and 
photocopy to extend available funds to 
provide free service to commercial agencies 
as directed by the National Library of 
Medicine. The Committee also heard 
reports on MEDLARS search formula- 
tion, hospital library workshops, and the 
regional union list of medical periodicals. 

The fourth meeting of the year was held 
on December 4 at which the Regional 
Medical Library Committee approved the 
formula by which interlibrary loan and 
free photocopy quotas are determined and 
the schedule of charges for over-the-quota 
use. Dr. Wayne Herron, Mr. Samuel Wat- 
ers, and Mr. Robert Walkington, members 
of the staff of the National Library of Med- 
icine attended the meeting as observers. Dr. 



ON THE LIBRARY 

Herron told the Committee than an em- 
bargoed list of journal titles was an alter- 
native to the quota system. Dr. Herron 
joined Elliott Morse in reporting on the 
meetings of regional medical library di- 
rectors and officers of the National Library 
of Medicine which were held on October 
24 and 25. Fred Bryant and Dr. Carroll 
Reynolds reported on library activities 
funded by the Susquehanna Valley and 
Western Pennsylvania Regional Medical 
Programs. The Chairman was directed to 
appoint a subcommittee to consider the es- 
tablishment of a list of common medical 
journals which could not be requested from 
the Regional Medical Library. The Sub- 
committee was also directed to maintain 
surveillance of the operation of the quota 
system. 

VISITING SURVEY COMMITTEE. 
This Committee, under the Chairmanship 
of George P. Berry, M.D., Dean Emeritus 
of the Harvard University School of Med- 
icine, began its survey of the College and 
its Library in January 1969 and continued 
its meetings through the Spring. Although 
the final report did not arrive until Jan- 
uary 1970, the Librarian and the officers 
of the College had access to preliminary 
sections of the report as written and to 
the report draft which was completed in 
September. 

Particularly helpful were working pa- 
pers prepared as the study progressed. Jess 
A. Martin wrote a paper on the salary 
scales and physical equipment and furnish- 
ings of the Library; Dr. David Kronick 
drafted a critique of the care and housing 
of the Library's historical collections; 
Erich Meyerhoff commented on the inade- 
quacies of the physical plant and its fur- 
nishings and the need for greater com- 
munity support; Dr. Richard H. Orr and 
Harold Bloomquist dealt with possible 
administrative reorganization. The original 
plan now calls for the appointment of an 
internal committee to receive the report 



ANNUAL REPORT ON THE LIBRARY 



323 



and to establish priorities concerning its 
implementation. 

WANTS AND NEEDS. Responses were 
received from 196 libraries to a question- 
naire designed to elicit information about 
the priorities which they would assign 
to certain improvements or expansion of 
regional medical library service. Opinion 
was solicited with costs considered and 
with costs disregarded. The votes were 
tabulated by types of libraries. The cost 
factor did not affect the rank of the first 
six choices which were (1) faster interli- 
brary loan and photocopy, (2) expanded 
reference services, (3) messenger service, 
(4) audio-visuals, (5) technician training, 
and (6) WATS (Wide Area Telephone Ser- 
vice) line. Lesser values were given to: vis- 
iting consultants, storage of duplicates, ex- 
hibits, acquisition and processing, and part- 
time temporary personnel bureau. Types 
of libraries which dissented from the popu- 
lar choice were health science schools, re- 
search and development libraries, and non- 
teaching hospitals. The research and 
development libraries placed a higher value 
. on expanded reference service. The health 
science schools gave top priority to a mes- 
senger service. 

TRAINING WORKSHOP. A succes- 
ful training session was held at the Col- 
lege on September 24 with instructional 
honors shared by Mrs. Caroline Morris, 
Librarian of the Pennsylvania Hospital, 
and Mrs. Beatrice Davis of the College. 
The workshop described regional inter- 
library loan and reference services to en- 
able hospital library personnel without 
formal training in librarianship to use 
regional library services and resources and 
to expand service to their own institu- 
tions. Plans for four other training ses- 
sions in other sections of the region were 
dropped because of conflicting programs 
offered under different auspices or due to 
lack of interest. 

REGIONAL MISCELLANEA. Equip- 
ment facilities of the regional program 



were strengthened by the purchase of: 
two 64-drawer card catalogs, a 3M model 
-100M microfilm reader printer and a ten- 
drawer file cabinet, a Fairchild Mark IV 
projector, a Wollensak #5730 tape re- 
corder, filing cabinets, desks, tables, chairs 
and typewriters. 

The Librarian of the College partici- 
pated in a one-day conference for hospital 
administrators, hospital-based medical ed- 
ucators, directors of nursing education, 
and others responsible for continuing 
education of hospital staff. The conference 
was held in the William Penn Memorial 
Museum in Harrisburg on October 23, 1969. 
It was sponsored by The College of Phy- 
sicians, the Hospital Association of Penn- 
sylvania, the Milton S. Hershey Medical 
Center, the Pennsylvania Department of 
Health, and the Pennsylvania Medical 
Society. Elliott Morse described the services 
of the Mid-Eastern Regional Medical Li- 
brary and displayed the Postgraduate Med- 
ical Institute "Mini" Library. 

The Librarian also participated in a 
two-day conference held at the Milton S. 
Hershey Medical Center Library, Novem- 
ber 20-21. Training of hospital library 
staff was emphasized. He also represented 
the Mid-Eastern Regional Medical Library 
Service at a two-day meeting of officers of 
the National Library of Medicine and 
regional medical library directors in Louis- 
ville on October 24 and 25. 

The Library acquired fifty-two 8 mm 
cartridge films produced or released by the 
National Audiovisual Center. They will 
be loaned to libraries which own a Fair- 
child Mark IV projector and agree to re- 
place any films which are damaged. Films 
may also be viewed at the College. A list of 
the available films was published in the 
Library's Booklist. 

Mrs. Beatrice Davis, Lee Tanen, Mrs. 
Michele Winters, and Elliott Morse spoke 
to the staff meeting of adult and young 
adult librarians at the Free Library of 
Philadelphia on December 9 on the med- 



324 



ANNUAL REPORT ON THE LIBRARY 



ical library network and implications for 
public library development. 

During the year the regional medical 
library service was visited by librarians 
interested in the Mid-Eastern service from 
Los Angeles, New York, Boston, Chicago 
and St. Louis. 

RESOURCE GRANT PROGRAM. 
The Resource Grant program for calendar 
year 1969 (the 03 year of the grant) per- 
mitted the employment of a Stack Super- 
visor to concentrate on problems of stacks 
housekeeping. Special attention was given 
to local shifting to relieve tight spots, pro- 
vision of boxes and envelopes for unbound 
issues, shelf reading and rearranging sec- 
tions of stack in bad order, and relabel- 
ling stack range ends. This long-needed 
restoration of order speeds the retrieval of 
volumes from the stacks and encourages 
more careful reshelving. 

The College Library Picture — 1969 

THE COLLEGE LIBRARY. Last 
year's report commented on the irony of 
the small portion of the report devoted to 
the Library itself in view of the fact that 
there would be no regional medical li- 
brary program without it. The allocation 
of 75% of the Librarian's salary to the re- 
gional budget is indicative of the neglect 
of the foundation upon which the regional 
program has been built. Its continuing 
strength is largely due to the extraor- 
dinary professional competence of the 
staffs of the Serials Department, the Pro- 
cessing Division, the Reference /Circula- 
tion desk. Its high morale may be attrib- 
uted to the devotion of the Assistant to 
the Librarian and the Library Secretary. 
Its continuing productivity owes much to 
the activity of the Historical Department 
and the Medical Documentation Service 
whose labors are reported elsewhere in 
this document. 

It would be entirely appropriate to 
reprint the portions of last year's re- 
port which decried the lack of space for 



books and staff. The only difference is the 
worsening of the situation by the addition 
of another year's books and journals. 

Backlogs in the Cataloging Department 
have almost been eliminated by the ardu- 
ous efforts of Mrs. Sarah Caspari, Mrs. 
Kathryn Miragliotta, Carmine Salvato and 
Josefa Sereda. Temporary summer help was 
engaged to restore order in a disaster area in 
the basement which houses the duplicate 
journal collection. The backlog of library 
materials awaiting collation has been 
brought under control thanks to the per- 
sistence of E. Naomi Frazer and the dili- 
gence of the paging staff. 

Binding. Eleven shipments were sent 
to the commercial bindery converting 
1213 volumes to a more manageable form. 
Members of the paging staff encased 1,742 
volumes in pamphlet covers. 953 items 
were dispatched from the Serials Depart- 
ment to the Workroom for processing. 

Job descriptions. At the suggestion of 
the Executive Director, members of the 
Library Staff were asked to prepare de- 
scriptions of their responsibilitities and 
library functions. 

S. Weir Mitchell Associates. During the 
year the following journals were endowed: 
American Scientist by George B. Goldman; ! 
Scandinavian Journal of Thoracic and 
Cardiovascular Surgery by Fitz Eugene 
Dixon; Laryngoscope by Philip Marden, 
Acta Paediatrica Scandinavica by Mrs. 
Beatrice F. Davis in memory of Mrs. Jessie | 

F. de Cani; Advances in Internal Medicine 
by George I. Blumstein in honor of Charles 

G. Blumstein. 

Changing of The Guard. The College 
Library is especially blessed to have two 
such enthusiastic boosters as Richard A. 
Kern and Francis C. Wood. It is entirely 
appropriate, therefore, that at the close of 
his three year term as President of the Col- 
lege, Dr. Wood should succeed Dr. Kern 
as the Honorary Librarian of The College 
of Physicians. Dr. Kern has brought dis- 
tinction to the already revered title of Hon- 



ANNUAL REPORT ON THE LIBRARY 



325 



orary Librarian which he has held since 
195(5. His intuitive sense of timing brought 
the plight of the independent medical 
society library to the attention of the Di- 
rector of the National Library of Medicine 
at a time when the concept of the regional 
medical library was only a dream. It was 
fir. Kern's personal commitment which 
guaranteed the success of the fund raising 
efforts in the early 1950's, leading to the 
remodelling of the College building and 
the construction of the stack addition. It 
is altogether fitting that he should be fol- 
lowed by the man who motivated the Col- 
lege's application to become the second 
regional medical library in the country. 

Equally noteworthy is the contribution 
of Samuel X Radbill, who retires at the 
end of 1969 as Chairman of the Library 
Committee. Dr. Radbill brought to the 
Chairmanship the rare combination of a 
scholar's interest in medical history and 
the practicing physician's appreciation of 
the value of current medical information. 
His intuition of administrative relation- 
ships kept the College Library on a pru- 
dent course. 

During the year, Drs. William T. 
Fitts, Jr., J. Gershon-Cohen, E. Harold 
Hinman, and Michael B. Shimkin served 
on the Library Committee. Dr. Hinman's 
retirement and Dr. Shimkin's move to the 
University of California, San Diego, at 
La Jolla, resulted in the appointment of 
John Franklin Huber and Walter B. Shelley 
to the Committee at year's end. 

Personnel. Maternity changed the ca- 
reers of Mrs. Joyce S. Mingledorff, Head 
of the Regional Reference Services; Mrs. 
Eileen Binckley, Readers Service Assistant; 
Mrs. Margaret Henry, Historical Assistant; 
and Mrs. Donna Parks, Library Page. Aca- 
demic interests caused the resignations of 
S. Augustus Young, part-time Serials As- 
sistant, Halina T. Wierzbicki, part-time 
Historical Assistant, Jean Conley, Page, and 
Stephan Bilynsky, Evaluation Assistant. 
Staff members who resigned to take other 



positions include Linda Howell, Patricia 
Boyle, and Patricia Porter. 

New appointments were Mrs. Rhea 
Brown, Readers Service Assistant; Mrs. 
Michele Winters, Regional Reference Li- 
brarian; James Butler, part-time Serials 
Assistant; and Patricia Fox, Timothy 
Phillips, Bernadette Baus, Margot van 
Rossum, Valerie Suber, and Thomas As- 
kins, as Library Pages. 

Lee J. Tanen, has accepted the position 
of Head of Regional Reference Services in 
addition to her duties as MEDLARS 
Search Formulator. Alice Mackov has 
joined the staff as MEDLARS Search 
Analyst. Mrs. Anne Schor is now the Re- 
gional Secretary and Barbara Cassady 
is Evaluation Clerk/Typist. Mrs. La- 
Verne K. Pittman was transferred from 
the Library Paging Staff to the Regional 
Photocopy and Teletype Section. Other 
personnel changes in the Historical Depart- 
ment and Medical Documentation Service 
are recorded in the corresponding sections 
of this report. 

Professional staff activity. The Library 
was represented at the 68th Annual Meet- 
ing of the Medical Library Association in 
Louisville by Alberta Berton, Mrs. Sarah 
Caspari, Mrs. Beatrice Davis, Mrs. Lisa- 
beth Holloway, Lee Tanen, Mrs. Michele 
Winters, and Elliott H. Morse who was 
installed as President of the Association 
during the sessions. Mrs. Davis serves the 
Association as a member of the Curriculum 
Committee. 

The Library was represented at the 
Third International Congress on Medical 
Librarianship held in Amsterdam in May 
by Elliott H. Morse. He was appointed 
as the United States representative on the 
Bridging Committee for the next Congress. 
He received the Distinguished Alumnus 
award from the Drexel Institute of Tech- 
nology School of Library Science in No- 
vember. 

Mrs. Lisabeth Holloway serves as Chair- 
man of the Philadelphia Regional Group 



326 



ANNUAL REPORT ON THE LIBRARY 



of the Medical Library Association tor the 
period July 1969 through June 1970. 

Miss E. Naomi Frazer is Secretary and 
member of the Executive Board of the Spe- 
cial Libraries Council of Philadelphia 8c 
Vicinity. 

Benefactors. A list of donors of books 
and other library materials appears in the 
statistical section of this report. 

The Library acknowledges its gratitude 
to the following institutions which have 
shared the operational costs of the College 
Library this year: 

NON-PROFIT INSTITUTIONS 

Alfred I. du Pont Institute 

Antioch College-Fels Research Institute 

Fitzgerald-Mercy Hospital 

Institute for Cancer Research 

Jefferson Medical College 

Lankenau Hospital 

Medical Literature, Inc. 

Pennsylvania College of Podiatric Medicine 

Pennsylvania Hospital 

Philadelphia College of Osteopathic Medicine 
Philadelphia General Hospital 
University of Pennsylvania School of Medicine 
Woman's Medical College of Pennsylvania 

CORPORATE INSTITUTIONS 

American Cyanamid Company (Lederle Laboratories) 

American Micromation Industries, Inc. 

American Sterilizer Company 

Atlas Chemical Industries 

James E. Beasley, Atty. 

Bell Telephone Company 

Bellis, Kolsby & Wolf, Atty. 

Campbell Soup Company 

Carroll Dunham Smith Pharmacal Company 

Cohen, Verlin & Shekman, Atty. 

Cooper Laboratories, Inc. 

Council for Tobacco Research 

Dechert, Price and Rhoads, Atty. 

Dilworth, Paxson, Kalish, Kohn & Levy, Atty. 

Duane, Morris & Heckscher 

E. I. du Pont (Haskell Laboratories) 



E. I. du Pont (Lavoisier Laboratories) 

E. I. du Pont (Stine Laboratories) 

Extracorporeal Medical Specialties, Inc. 

EMC Corporation (American Viscose) 

Stephen M. Feldman, Atty. 

Freedman, Borowsky & Lorry, Atty. 

General Electric Company 

General Technical Services 

Evelyn Goldstein 

Hollman-LaRoche, Inc. 

Information Interscience, Inc. 

International Pharmaceutical Corporation 

Johnson & Johnson Company 

Kisselman, Devine, Dcighan & Montano, Atty. 

Krusen, Evans & Byrne, Atty. 

LaBrum & Doak, Atty. 

Lea Associates, Inc. 

Litvin and Rutter, Atty. 

Charles Lowenthal, Atty. 

McNeil Laboratories 

Malis &: Feldman, Atty. 

Manccl, Lundy & Lessin, Atty. 

Mead Johnson Company 

Medical Programs, Inc. 

Merck Frosst Laboratories 

Merck Sharp & Dohme 

Morgan, Lewis & Bockius, Atty. 

National Drug Company 

Norwich Pharmacal Company 

Penn Central Railroad Co. 

Pennwalt Chemical Company 

Pepper, Hamilton & Scheetz, Atty. 

Perskie & Perskie, Atty. 

Quaker Chemical Company 

Radio Corporation of America 

Ramsdell, Burkley & Co., Inc. 

Roche Bioelectronics Division (Hoffman-LaRoche, 

Inc.) 

Rodale Press, Inc. 

Rohm & Haas Company 

William H. Rorer, Inc. 

Schnader, Harrison, Segal & Lewis, Atty. 

Shein & Mele, Atty. 

Smith Kline & French Laboratories 

Sidney J. Smolinsky, Atty. 

E. R. Squibb Research Institute 

Paula Stone 

Sun Oil Company 

Wallace Laboratories 



ANNUAL REPORT ON THE LIBRARY 



327 



STATISTICAL SUMMARY 
Inventory 

1969 1968 

Accessioned items 1 : 

Incunabula' 421 421 

Manuscripts and typescripts 1,342 1,326 

General 248,711 243,402 

Accessioned pamphlets 9,566 8,775 

260,040' 253,924' 



Unaccessioned items 1 : 

Reports 28,822 28,820 

Theses 62,855 62,342 

Pamphlets and reprints 228,542 228,536 

320,219 319,698 



Accessioned Acquisitions : 

1969 : 6,116 (2,941 by purchase; 2,869 by gift; 306 by exchange). (Books: 2,984; Periodicals: 2,341; 
Pamphlets: 791) 

1968: 6,224 (2,811 by purchase; 2,938 by gift; 475 by exchange). (Books: 2,681; Periodicals: 2,767; 
Pamphlets: 776) 
Non-accessioned acquisitions : 

1969: 167 items (Reports, 2; Theses, 110; Miscellaneous, 55). 
1968: 141 items (Reports, 2; Theses, 99; Miscellaneous, 40). 



Currently Received Serials 





Subscription 


Gift 


Exchange 


Total 


U.S.A 


608 


446 


71 


1125 




868 


82 


134 


1084 




151 


43 


65 


259 




153 


26 


29 


208 




97 


78 


74 


249 




43 


48 


68 


159 




19 


12 


8 


39 


Pacific (including Australasia) 


14 


9 


10 


33 




2 


7 


17 


26 


Grand Total 1969 (Dec. 31) 


1955 


751 


476 


3182' 


Grand Total 1968 (Dec. 31) 


1977 


792 


479 


3248' 



New Titles: A total of 1 13 new serial titles was added in (1 Nov. '68-3 Dec. '69). Separate issues received, 
checked in the Kardex record and shelved totaled 22,287. 



Accessioned items in this library comprise the 
total number of bound volumes and such unbound 
pamphlets as have been cataloged as separate bib- 
liographical units regardless of their size. 

There remain many thousands of unaccessioned 
pamphlets awaiting accessioning and cataloging. A 
true quantitative and qualitative picture of the 
library's holdings cannot be presented until this 
wealth of neglected material has been processed and 
duly registered in our 'accessioned' count. 

2 The Library owns 423 incunabula, but there are 



two cases of two bound together, reducing the num- 
ber of accessioned items. 

8 Included in these figures are the following col- 
lections which are on permanent deposit in the 
Library: Gross Library, 3,976 accessioned items; 
Parry Library of the Obstetrical Society of Phila- 
delphia, 217; Miitter Museum, 200 (Mutter Museum 
books may not be removed from the College build- 
ing)- 

4 Titles are only included in this count if issues 
were received in 1968 or 1969. 



328 



ANNUAL REPORT ON THE LIBRARY 



Readers' Use of the Library 

Library Hours: The Library was open, during the academic year, from 9:00 A.M. to 9:30 P.M. on Mon- 
days and Wednesdays, from 9:00 A.M. to 5:00 P.M. on other weekdays. During June, July, August and 
until the first Monday after Labor Day, the Library was open from 9:00 A.M. to 9:00 P.M. on Tuesdays 
and from 9:00 A.M. to 5:00 P.M. on other weekdays, except Saturdays when it was closed. The follow- 
ing legal holidays were observed: Thanksgiving, Christmas, New Year's, Memorial, Independence, and 
Labor Days. 



Visitors: 



I'll ,< i 
1968 



Reading Room 
7,368 

8,802 



Periodicals Room 

3,747 
3,804 



Totals 

11,115 
12,606 



Circulation: 



1968 



Intra-Mural s 

26,188 
27,450 



Extra-Mural 

25,866 
35,464 



Totals 

52,054 
62,914 



l'«)'i 
1968 



Books 

10,474 
1 1 , 749 



Journals 

41,580 s 
51.165 7 



Totals 
52,054 
62,914 



Interlibrary Loans: The Library sent 56,214 (1968: 47,706) volumes on interlibrary loan. 8 Included in 1969 
figures are 30,615 articles photocopied with Resource and Regional Grant support, but not the photo- 
duplications noted immediately below. 

Photoduplications : 192,300 pages were photocopied on request (1968: 171,453). Users of this service reim. 
burse the College Library for copying and bookkeeping costs. 

Donations 

The donors for the past year number 60 (1968: 89). The library is indebted for large gifts of books* 
pamphlets and unbound periodicals to the following donors: American College of Physicians; Drs. J. M- 
Fruchter, E. R. Long; National Foundation; Dr. F. B. Rogers; Smith Kline & French Laboratories; 
Wallace Laboratories, and Woman's Medical College. 

Various publishing houses, among the large group of corporate donors, have presented volumes as 
follows: F. A. Davis Company, 45; Lea & Febiger, 12; J. B. Lippincott Co., 57; W. B. Saunders Co., 73. 

Other individual donors were as follows : Dr. H. J. Abrahams; Mr. L. P. Appleman; Drs. T. C. Barnes, 
R. A. Boyer; Mr. F. D. Bryant; Dr. T. Cianfrani; Capt. J. W. Cox; Drs. A. P. Fishman, F. G. Giller, 
R. J. Gould, S. B. Hadden; Mrs. A. Kanofsky; Drs. I. H. Kornblueh, T. H. Leopold, E. B. LeWinn, 
J. B. Light; M. B. Lurie Estate; Drs. J. L. McClenahan, E. H. McGehee, B. Malzberg, M. Naide, S. 
X Radbill, R. H. Roberts, C. E. Rosenberg; Mrs. J. B. Rudolphy; Drs. H. G. Scheie, J. A. Sterling, S. 
B. Sturgis, F. W. Sunderman, J. M. Thorington, and R. G. Tronzo. 

The Transactions & Studies was sent, either in exchange or as gift, to 569 organizations. 

Theses and dissertations to the number of 513 have been received on exchange from the following Euro- 
pean schools of medicine: Universities of Basel, Bern, Erlangen, Geneva, Karolinska Institute, Lausanne, 
Leiden, Liege, Louvain, Lund, Uppsala, and Utrecht. 

Elliott H. Morse 
Librarian 



5 The number of volumes "consulted in the li- 
brary" includes only those supplied on demand. 
Readers have access to the bound volumes of pe- 
riodicals and reference works kept on the shelves 
in the Reading Room; the Fellows, and occasionally 
others, by special permission, have access to the book 
stacks. There are, therefore, many volumes con- 
sulted of which no accurate record can be kept. 



e This figure includes 6,976 unbound current jour- 
nal issues circulated from the Periodicals Room. 

'This figure includes 5,426 unbound current 
journal issues circulated from the Periodicals Room. 

8 The count of states, territories and foreign coun- 
tries to which loans were sent has been dropped. 
The development of regional networks makes this 
statistic less meaningful. 



ANNUAL REPORT ON THE LIBRARY 



329 



Library Historical Collections 

1. Curator's Report 

Visitors to the Packard-Krumbhaar Al- 
cove during the year could hardly have 
failed to be impressed by the concrete evi- 
dence — in the form of added staff and 
book-laden tables and trucks — that cata- 
loguing and reference activities were pro- 
ceeding apace, thanks in part to the 
continuing financial support from the 
American Philosophical Society. Specific 
references to some of these activities may 
be found, of course, in the Associate Cu- 
rator's report, below. It is a matter of re- 
gret that the Alcove's limited space, in 
conjunction with the staff activities, sel- 
dom provides the visiting scholar with the 
customary and desirable lack of aural and 
visual distractions. 

Acquisitions. The following two para- 
graphs were contributed by Mrs. Hollo- 
way to the November report to the Library 
Committee: 

"In October, Dr. Esmond Long made 
a gift to the College of a number of 
books and pamphlets from his own library 
— a further gift. Many of these have been 
added to our collections; the duplicates in 
the field of medical history were offered, 
with Dr. Long's concurrence, as a gift to 
Hershey Medical Center Library, along 
with some fairly substantial runs of du- 
plicate journals, some from Dr. Long's 
collection. . . . Hershey has accepted these 
with thanks." 

"In November, we were invited to exam- 
ine the library of Max B. Lurie (1893— 
1966), Fellow of this College, and take 
from it any items of medical interest 
which we might want. We did so, taking 
certain comparatively recent printed ma- 
terials on tuberculosis, about 5 linear feet of 
Dr. Lurie's correspondence, and the type- 
script of his book entitled Resistance to 
Tuberculosis: Experimental Studies in 



Native and Acquired Defensive Mecha- 
nisms (1964)." 

Our late Fellow Dr. Theodore Cian- 
frani's (1899-1968) regard for the library's 
historical collections — developed in large 
measure during the period when he was 
preparing his Short History of Obstetrics 
and Gynecology (1960) — was signalized 
by his widow's fulfillment of his wish that 
his copy of a London edition of William 
Hunter's Anatomy of the Gravid Uterus 
be donated to the library. The undated 
edition turned out to be comparable, but 
happily not identical, with one in the col- 
lections. 

Our extensive S. Weir Mitchell mate- 
rial — of continuous interest to medical 
historians — was gratefully enriched, 
through the then-President of the College, 
Dr. Francis C. Wood, by two items 
thoughtfully donated by another Fellow of 
the College, Dr. Edward H. McGehee: 

(1) a 4-line, typewritten poem inscribed 
"Harriet Frazier from Weir Mitchell"; and 

(2) a signed, manuscript letter to the same 
written in Bar Harbor, Maine. 

The following purchase would also 
seem to merit recording: Mackenzie, Sir 
George Stewart (1780-1848): Illustrations 
of Phrenology. 17 plates. Edinburgh, 1820. 

An historical item with more than casual 
association value to the College was re- 
ceived from one of its Fellows, Dr. Samuel 
B. Hadden, after its formal presentation 
to the Council of the College. It is a copy 
of Sir William Osier's exceedingly rare 
Thomas Linacre, published by the Cam- 
bridge (England) University Press, in 1908, 
which bears the following inscription: 
"J.G. Clark from his friend W m Osier Ox- 
ford Aug. 3rd '08". Dr. Clark (elected to 
the fellowship in 1899) was Professor of 
Gynecology in the University of Penn- 
sylvania. Accompanying the little book are 
(1) "one of Dr. Osier's famous penny 
post cards" (Dr. Hadden's description) ad- 
dressed to Dr. James Wendell Reber (1867- 



330 



ANNUAL REPORT ON THE LIBRARY 



1916), a prominent Philadelphia ophthal- 
mologist, though not a Fellow of the Col- 
lege; (2) a holograph note (1950) from 
Dr. Robert J. Hunter (Fellow) to Dr. Had- 
den, inquiring about this copy, and a 
copy of Dr. Fladden's reply, which docu- 
ments the rarity of the edition; (3) Dr. 
Hadden's presentation-letter to President 
Francis C. Wood, with a copy of Dr. 
Wood's letter-of-thanks to Dr. Hadden. As 
a touching and fitting climax to this rec- 
ord, we note that, tipped into the little 
volume, there is a statement, signed by 
Dr. Hadden, that reads as follows: "Pre- 
sented to the Philadelphia College of 
Physicians as an expression of admiration 
and appreciation for the activities of 
Samuel X Radbill, M.D. in behalf of the 
Library of the College and its many other 
activities." 

Exhibits. Exhibits were prepared, and 
displayed in the lower lobby, for the fol- 
lowing occasions: (1) the February program 
of the Section on Medical History; (2) 
the College's February forum entitled 
'Population Avalanche'; (3) the Section on 
Medical History's and the Woman's Med- 
ical College of Pennsylvania's Kate Hurd 
Mead Lecture XX (April); (4) a summer 
exhibit drawing upon (a) a colorful col- 
lection of 19th/20th century pharmaco- 
therapeutic card advertisements that had 
recently been presented by a Fellow and 
frequent donor, Dr. J. Monroe Thoring- 
ton, and (b) more substantial material on 
the same subject that was selected and 
arranged by the Associate Curator; (5) the 
centennial of the birth of Harvey W. Cush- 
ing (Sept.); (6) the lecture by Ralph Nader 
on 'Consumer Protection' (Sept.); (7) the 
College's James M. Anders Lecture (Nov.); 
(8) a visit from members of the American 
Public Health Association (Nov.); (9) the 
November meeting of the College's Section 
on Medical History; (10) a representative 
collection of hitherto uncatalogued items 
in the historical collections that are now 



being catalogued, thanks to the Ameri- 
can Philosophical Society grant (Dec). 

Fugitive Leaves. More pressing com- 
mitments again resulted in the publica- 
tion of only one number: N.s., No. 92 
(May 1969), Table of Contents and Index, 
N.s., Nos. 76-91. 

Miscellaneous. Xerox copies of manu- 
script materials in (a) the Gilbert Col- 
lection; (b) the College's first Minute 
Book; (c) the College's Manuscript Ar- 
chives were sent, on request, to the Na- 
tional Historical Publications Commis- 
sion, Washington, D.C. They are scheduled 
to be published in two of the Commis- 
sion's documentary projects: Ratification 
of the Constitution; The First Federal 
Congress. 

A List of the Kate Hurd Mead Lectures 
in Medical History, I-XX, compiled by 
the Curator, was published in the Oct., 
1969, issue of the College's Transactions & 
Studies. 

W. B. McDaniel, 2d 
Curator, Library 
Historical Collections 

2. Report of the Associate Curator and 
Cataloguer of Historical Materials. 

Items Catalogued 

Books added to the collection (including 
early and current works on the history 
of medicine, and gift books, also in- 
cluding volumes added to existing 
serials or sets) 832 

Pamphlets (all but 17 having been done 

on the APS grant) 744 

Pictures, documents, and manuscripts 187 

Books and pamphlets recatalogued (be- 
cause of misleading cards, erroneous 
entries, or misleading location sym- 
bols) 85 

1,848 

Cards prepared 10,717 

Special Activities 

American Philosophical Society Project. 
During 1969, work on cataloguing of the 
pamphlet collections was continued by 



ANNUAL REPORT 

Mrs. Elizabeth Bready, part-time cata- 
loguer, and, at the close of the year, was 
augmented by the addition of another 
part-time cataloguer, Miss Frances Wright. 
Mr. Steven Peitzman continued as part- 
time searcher. The Associate Curator's 
part of this project, which is to recatalogue 
the manuscripts with a view toward pub- 
lication of a catalogue, has also proceeded, 
although slowly, because of an increasing 
multiplicity of calls upon her time. One 
hundred and fifty-five of the "major" manu- 
scripts — not including single-page docu- 
ments, letters, or autographs — have been 
prepared. 

New Arrangements for Use of the Li- 
brary's Historical Materials. In August, 
1969, the Historical Department under- 
took full service of the Cage, Gross, and 
Wood collections, requiring patrons — in 
most cases — to use these valuable materials 
in the Packard-Krumbhaar Alcove, and re- 
stricting access to the Cage and Gross and 
Wood bookcases to the President, Exec- 
utive Director, the Librarian and his As- 
sistant, and the staff of the Historical De- 
partment. These changes were made to 
insure greater safety and care in handling 
of these fragile and valuable materials. 

In September, Miss Dagmar Nemecek 
came to us as Historical Assistant for Pag- 
ing and Book Preservation, with certain 
clerical duties as well. The fact that this 
position is now full-time rather than part- 
time, as formerly, has enabled us to ini- 
tiate some new indexing projects, partic- 
ularly involving scrapbooks of fairly recent 
date. In response to the growing concern 
expressed by librarians and book experts 
throughout the country for the survival of 
virtually all journals, books and pamph- 
lets — and our own are emphatically to be 
included in this endangered category — 
from the "bad paper" period (ca. 1870 to 
the present time), new techniques in book 
preservation have been explored by the 
Associate Curator during 1969, with some 
outside assistance, and with the encourage- 



ON THE LIBRARY 331 

ment of the College and Library adminis- 
tration. Plans have been formulated to 
alter and augment our presently very 
limited efforts in the field of preservation. 
These additional activities cannot, of 
course, be carried on in the Packard-Krum- 
bhaar Alcove, which is already seriously 
overcrowded, in spite of diligent efforts at 
rearrangement. 

Summer Career Intern. Having been 
informed by Macalester College, in St. 
Paul, Minnesota, of its program to place 
members of its junior class in summer jobs 
related to their ultimate field of work, we 
obtained the services of Miss Linnea Soder- 
gren, a prospective library-school candi- 
date, for June, July, and August. During 
this period she assisted in the searching of 
gift books through our catalogues, and also 
"calendared," or listed in some detail, the 
original letters, engravings, etc., compiled 
by Joseph Carson (1808-1876) into the 
first of a series of scrapbooks previously 
not analyzed. This summer's experience, 
financed in our case by Macalester 's special 
funds, has proved valuable both to us and 
to the Intern, and we are prepared to 
repeat it, if opportunity offers. 

Incidentally, in this connection, perhaps 
it should be noted that the Associate 
Curator has adopted a similar project — 
extra-curricular — of "calendaring" the 
contents of a large series of homoeopathic 
pamphlet volumes given to us by Hahne- 
mann Medical College Library. The his- 
tory of homoeopathy is a relatively unex- 
plored field, and it is hoped that this ac- 
tivity will ultimately be of service to re- 
searchers. Also as an extra-curricular proj- 
ect, the Associate Curator — and her elder 
son — have undertaken the indexing and 
alphabetizing of mid-19th Century Amer- 
ican medical obituaries appearing in the 
Transactions of the American Medical 
Association from 1850 onwards, and not 
generally noted elsewhere. Eventually we 
plan to publish this list as an aid to other 
persons exploring the sometimes rather 



332 



ANNUAL REPORT ON THE LIBRARY 



arid regions of latter 19th-century Ameri- 
can medical biography. 

Sale of Historical Duplicates. During 
1969, one regular, miscellaneous List of 
Duplicates from the Historical Collections 
(no. 8) was issued, containing 94 items, of 
which 40 were sold. One special list, (no. 
EE) on obstetrics and gynecology, was is- 
sued, containing both historical and recent 
duplicates, to the number of 287; of these, 
69 were sold. Counting in items sold from 
previous lists, and those sold to persons 
who made special inquiry regarding un- 
listed items, sales of duplicates by the 
Historical Department totalled 184 for the 
year. 

LlSABETH M. HOLLOWAY 

Associate Curator, Library 
Historical Materials 

Medical Documentation Service 

The data processing systems adopted 
late in 1967, the use of which increased 
during 1968, underwent further changes in 
1969. Early in the year the Service Bureau 
Corporation of IBM made the decision 
to discontinue its on-line facilities for 
data processing; effective in the fall of 
the year. A careful survey of other service 
bureaus providing a dedicated text facil- 
ity, gave little encouragement for replace- 
ment before the cut-off date for existing 
services. Consequently, a new graphic arts 
computer system was installed early in 
September to provide continuity of pub- 
lication and closer control on the three ab- 
stracting journals published by MDS, 
namely BIRTH DEFECTS, INFLUENZA 
and CYSTIC FIBROSIS. With little or no 
interruption, the transition was made fol- 
lowing a training program for the staff pro- 
vided by IBM. 

Mrs. Elizabeth Wright, previously 
trained to operate the 2741 administrative 
terminal, became more versatile with the 
advent of the new MTSC system and was 
appointed supervisor of the communica- 
tions system including the 2741 ATS 



terminal, the MTSC (magnetic tape selec- 
tric composer), and the Mid-Eastern Re- 
gional Medical Library Service teletype 
communications system. Working with 
Mrs. Wright are Miss Linda Justice and 
Miss Anne McGinnis. 

Miss Alberta D. Berton continued to 
serve as Director of MDS. Among her 
many professional obligations, she became 
President of the Special Libraries Council 
of Philadelphia and Vicinity and Chair- 
man of the Annual National Information 
Retrieval Colloquium, which will be held 
in Philadelphia May 7-8, 1970. As Editor 
of the JIM List, a publication of the Phila- 
delphia Regional Group of the Medical 
Library Association, Miss Berton will pro- 
duce the 1970 edition this year as a com- 
puter operation rather than the hand paste- 
up of previous years. COPNIP (Committee 
on Pharmacomedical Nonserial Industrial 
Publications) a publication of the Pharma- 
ceutical Division of the Special Libraries 
Association, gained wider recognition and 
subscriptions increased sizeably under Miss 
Berton's guidance and efforts as Business